Ethnic and Gender Differences in the Functional Disparities after Primary Total Knee Arthroplasty
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The benefits of TKA have been well documented. Whether these benefits apply equally across gender and ethnic groups is unclear. Given the underuse of TKA among certain demographic groups, it is important to understand whether gender or ethnicity influence pain and function after TKA.
We determined (1) the influence of race, gender, and body mass index (BMI) on primary TKA functional scores and ROM before gender-specific implants; and (2) whether comorbidities influenced ROM and functional scores.
Patients and Methods
We reviewed all 202 patients who underwent primary TKAs in 2004. We contacted 185 of the 202 patients, including 90 African-Americans, 87 Caucasians, four Asians, and four Hispanics (55 men, 130 women). Their average age was 66 years, and average BMI was 34.4 (range, 20–55). Knee Society scores (KSS) and ROM, patient demographics, and the Charlson Comorbidity Index (CCI) were recorded. Minimum followup was 24 months (average, 29.1 months; range, 24–60.3 months).
African-Americans had longer delays to presentation, higher BMI, and worse 2-year KSS. Women (all races) had higher BMI and worse preoperative flexion/arc ROM. African-American women had worse final ROM and had similar final gains in ROM (postoperative minus preoperative ROM) after controlling for confounders.
Gender and race affected functional KSS and ROM variables. The worse results experienced by African-American women may be attributable to a longer delay to presentation. However, the scores and motion were high for all subgroups, and underuse of TKA in women and African-Americans cannot be justified based on a perception of lesser functional gains.
Level of Evidence
Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
- Allen KD, Helmick CG, Schwartz TA, DeVellis RF, Renner JB, Jordan JM. Racial differences in self-reported pain and function among individuals with radiographic hip and knee osteoarthritis: the Johnston County Osteoarthritis Project. Osteoarthritis Cartilage. 2009;17:1132–1136. CrossRef
- Blaha JD, Mancinelli CA, Overgaard KA. Failure of sex to predict the size and shape of the knee. J Bone Joint Surg Am. 2009;91(suppl 6):19–22. CrossRef
- Borkhoff CM, Hawker GA, Kreder HJ, Glazier RH, Mahomed NN, Wright JG. Patients’ gender affected physicians’ clinical decisions when presented with standardized patients but not for matching paper patients. J Clin Epidemiol. 2009;62:527–541. CrossRef
- Borrero S, Kwoh CK, Sartorius J, Ibrahim SA. Brief report: gender and total knee/hip arthroplasty utilization rate in the VA system. J Gen Intern Med. 2006;21(suppl 3):S54–S57. CrossRef
- Chang HJ, Mehta PS, Rosenberg A, Scrimshaw SC. Concerns of patients actively contemplating total knee replacement: difference by race and gender. Arthritis Rheum. 2004;51:117–123. CrossRef
- Dunlop DD, Manheim LM, Song J, Sohn MW, Feinglass JM, Chang HJ, Chang RW. Age and racial/ethnic disparities in arthritis-related hip and knee surgeries. Med Care. 2008;46:200–208. CrossRef
- Escalante A, Barrett J, del Rincon I, Cornell JE, Phillips CB, Katz JN. Disparity in total hip replacement affecting Hispanic Medicare beneficiaries. Med Care. 2002;40:451–460. CrossRef
- Ezenwa MO, Ameringer S, Ward SE, Serlin RC. Racial and ethnic disparities in pain management in the United States. J Nurs Scholarsh. 2006;38:225–233. CrossRef
- Fehring TK, Odum SM, Hughes J, Springer BD, Beaver WB Jr. Differences between the sexes in the anatomy of the anterior condyle of the knee. J Bone Joint Surg Am. 2009;91:2335–2341. CrossRef
- Gandhi R, Dhotar H, Razak F, Tso P, Davey JR, Mahomed NN. Predicting the longer term outcomes of total knee arthroplasty. Knee. 2010;17:15–18. CrossRef
- Green CR, Baker TA, Smith EM, Sato Y. The effect of race in older adults presenting for chronic pain management: a comparative study of black and white Americans. J Pain. 2003;4:82–90. CrossRef
- Halbert CH, Armstrong K, Gandy OH Jr, Shaker L. Racial differences in trust in health care providers. Arch Intern Med. 2006;166:896–901. CrossRef
- Hawker GA, Wright JG, Coyte PC, Williams JI, Harvey B, Glazier R, Badley EM. Differences between men and women in the rate of use of hip and knee arthroplasty. N Engl J Med. 2000;342:1016–1022. CrossRef
- Ibrahim SA. Racial and ethnic disparities in hip and knee joint replacement: a review of research in the Veterans Affairs Health Care System. J Am Acad Orthop Surg. 2007;15(suppl 1):S87–S94.
- Jha AK, Fisher ES, Li Z, Orav EJ, Epstein AM. Racial trends in the use of major procedures among the elderly. N Engl J Med. 2005;353:683–691. CrossRef
- Joshy S, Datta A, Perera A, Thomas B, Gogi N, Kumar Singh B. Ethic differences in preoperative function of patients undergoing total knee arthroplasty. Int Orthop. 2006;30:426–428. CrossRef
- Karlson EW, Daltroy LH, Liang MH, Eaton HE, Katz JN. Gender differences in patient preferences may underlie differential utilization of elective surgery. Am J Med. 1997;102:524–530. CrossRef
- Kostamo T, Bourne RB, Whittaker JP, McCalden RW, MacDonald SJ. No difference in gender-specific hip replacement outcomes. Clin Orthop Relat Res. 2009;467:135–140. CrossRef
- Lavernia CJ, Alcerro JC, Rossi MD. Fear in arthroplasty surgery: the role of race. Clin Orthop Relat Res. 2010;468:547–554. CrossRef
- LaViest TA, Gaskin DJ, Richard P. The economic burden of health inequalities in the United States. Joint Center for Political and Economic Studies. 2009. Available at: http://www.jointcenter.org/publications_recent_publications/health/the_economic_burden_of_health_inequalities_in_the_united_states. Accessed November 12, 2009.
- MacDonald SJ, Charron KD, Bourne RB, Naudie DD, McCalden RW, Rorabeck CH. The John Insall Award. Gender-specific total knee replacement: prospectively collected clinical outcomes. Clin Orthop Relat Res. 2008;466:2612–2616. CrossRef
- McBean AM, Gornick M. Differences by race in the rates of procedures performed in hospitals for Medicare beneficiaries. Health Care Financ Rev. 1994;15:77–90.
- Merchant AC, Arendt EA, Dye SF, Fredericson M, Grelsamer RP, Leadbetter WB, Post WR, Teitge RA. The female knee: anatomic variations and the female-specific total knee design. Clin Orthop Relat Res. 2008;466:3059–3065. CrossRef
- National Institutes of Health. NIH Consensus Statement on total knee replacement. NIH Consens State Sci Statements. 2003;20:1–34.
- Nelson CL. Disparities in orthopaedic surgical intervention. J Am Acad Orthop Surg. 2007;15(suppl 1):S13–S17.
- O’Connor MI. Sex differences in osteoarthritis of the hip and knee. J Am Acad Orthop Surg. 2007;15(suppl 1):S22–S25.
- Rankin EA, Bostrom M, Hozack W, Jacobs JJ, McCarthy JC, O’Connor MI, Trippel SB, Turkelson C. Gender-specific knee replacements: a technology overview. J Am Acad Orthop Surg. 2008;16:63–67.
- Santaguida PL, Hawker GA, Hudak PL, Glazier R, Mahomed NN, Kreder HJ, Coyte PC, Wright JG. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg. 2008;51:428–436.
- Schulman KA, Berlin JA, Harless W, Kerner JF, Sistrunk S, Gersh BJ, Dube R, Taleghani CK, Burke JE, Williams S, Eisenberg JM, Escarce JJ. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340:618–626. CrossRef
- Skinner J, Weinstein JN, Sporer SM, Wennberg JE. Racial, ethnic, and geographic disparities in rates of knee arthroplasty among Medicare patients. N Engl J Med. 2003;349:1350–1359. CrossRef
- Skinner J, Zhou W, Weinstein J. The influence of income and race on total knee arthroplasty in the United States. J Bone Joint Surg Am. 2006;88:2159–2166. CrossRef
- SooHoo NF, Lieberman JR, Ko CY, Zingmond DS. Factors predicting complication rates following total knee replacement. J Bone Joint Surg Am. 2006;88:480–485. CrossRef
- Tamayo-Sarver JH, Hinze SW, Cydulka RK, Baker DW. Racial and ethnic disparities in emergency department analgesic prescription. Am J Public Health. 2003;93:2067–2073. CrossRef
- Wang Y, Simpson JA, Wluka AE, Urquhart DM, English DR, Giles GG, Graves S, Cicuttini FM. Reduced rates of primary joint replacement for osteoarthritis in Italian and Greek migrants to Australia: the Melbourne Collaborative Cohort Study. Arthritis Res Ther. 2009;11:R86. CrossRef
- Weng HH, Kaplan RM, Boscardin WJ, Maclean CH, Lee IY, Chen W, Fitzgerald JD. Development of a decision aid to address racial disparities in utilization of knee replacement surgery. Arthritis Rheum. 2007;57:568–575. CrossRef
- Winiarsky R, Barth P, Lotke P. Total knee arthroplasty in morbidly obese patients. J Bone Joint Surg Am. 1998;80:1770–1774.
- Ethnic and Gender Differences in the Functional Disparities after Primary Total Knee Arthroplasty
Clinical Orthopaedics and Related Research®
Volume 468, Issue 12 , pp 3355-3361
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- 2. Department of Orthopaedic Surgery, Penn Presbyterian Medical Center, Cupp 1, 39th and Market Streets, Philadelphia, PA, 19104, USA
- 3. Orthopaedic Reconstructive Surgery, Geisinger Medical Center, Danville, PA, 17822, USA