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Racial Differences in Patient-Reported Outcomes After Total Joint Arthroplasty
Isabel Prado1, Mahveen Jahan2, Mark Wu3
1Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina.
Background:
Racial differences in total joint arthroplasty (TJA) remain poorly defined. The purpose of this study was to investigate racial/ethnic differences in postoperative clinical and patient-reported functional outcomes between non-Hispanic White, African American, Hispanic, Asian, and Native American populations using the American Joint Replacement Registry.
Methods:
All primary TJAs from 2012 to 2022 with reported race/ethnicity and a minimum of 1-year follow-up data were retrospectively reviewed. Patient-reported outcome measures were evaluated based on identified racial differences. Descriptive statistics were performed using a Chi-square, Fisher exact tests, or analyses of variance (ANOVA). Multivariate regression models were used to assess for predictors of functional outcomes. Statistical significance was set at P < 0.05. There were 896,154 total hip arthroplasties (THAs) and 1,401,359 total knee arthroplasties (TKAs) evaluated. The population of THAs was 88% White and 55% women, and their mean age was 66 years. The population of TKAs was 85% White and 61% women, and their mean age was 68 years.
Results:
In the multivariate logistic regression model, Asian patients had a significantly decreased odds of achieving minimal clinically important difference after TJA compared to White patients (P = 0.02, THA; P < 0.01, TKA). Overall postoperative functional scores were significantly lower among African American (P < 0.01) and Hispanic (P < 0.01) patients after THA and significantly lower among African Americans (P < 0.01), Asians (P < 0.01), and Hispanics (P < 0.01) after TKA.
Conclusions:
Differences in outcomes among racial and ethnic groups are evident in TJA. Although all races saw improvement in patient-reported outcome measures preoperatively to postoperatively, Asians may have decreased odds of achieving minimal clinically important difference compared to White patients. Further study is required to identify causes for these differences as well as possible ways to augment the outcomes of minority patients.
