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Age and Racial Disparities in Manipulation Rates Following Total Knee Arthroplasty: An 11-Year Review.

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Younger age and Black/African American race are linked to higher rates of manipulation under anesthesia (MUA) after total knee arthroplasty (TKA). This finding aids in managing patient expectations and allocating resources for successful knee replacement outcomes.

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Area of Science:

  • Orthopedic Surgery
  • Patient Outcomes Research

Background:

  • Postoperative stiffness is a common complication after total knee arthroplasty (TKA).
  • Manipulation under anesthesia (MUA) is used to treat early stiffness.
  • Factors influencing MUA incidence, such as patient demographics and social factors, require further investigation.

Purpose of the Study:

  • To evaluate the impact of patient-related factors on the incidence of MUA following primary TKA.
  • Specifically assess the influence of employment status, marital status, social support, and language barriers on MUA rates.
  • Identify demographic and social predictors of MUA after TKA.

Main Methods:

  • Retrospective review of a prospectively gathered multicenter database (July 2012 - December 2023).
  • Inclusion of patients undergoing primary TKA with subsequent MUA within 16 weeks.
  • Analysis of demographic variables, employment, marital status, primary language, and Area Deprivation Index (ADI).
  • Statistical analysis using t-tests, chi-square tests, and multivariate/matched case-control logistic regression.

Main Results:

  • Out of 6,110 primary TKA patients, 265 (4.3%) underwent MUA within 16 weeks.
  • The MUA cohort was significantly younger (median 67 vs. 73 years) and more likely to be Black/African American (10.3% vs. 4.3%).
  • Younger age and Black/African American race were independently associated with higher MUA rates.
  • Employment status (except disabled), marital status, primary language, and ADI did not significantly impact MUA incidence.

Conclusions:

  • Younger age and Black/African American race are significant predictors of MUA following TKA.
  • These findings highlight potential disparities in TKA outcomes.
  • Further research is warranted to understand the underlying causes and develop targeted interventions.
  • Results can inform physician-patient communication and resource allocation for improved TKA recovery.