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Examining racial disparities in utilization rate and perioperative outcomes following knee and hip arthroplasty

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Previous arthroplasty utilization research predominantly examined Black and White populations within the US. This is the first known study to examine utilization and complications in poorly studied minority racial groups such as Asians and Native Hawaiian/Pacific-Islanders (NHPI) as compared to Whites.

Results

Data from 3304 primary total hip and knee arthroplasty patients (2011 to 2019) were retrospectively collected, involving 1789 Asians (52.2%), 1164 Whites (34%) and 320 Native Hawaiians/Pacific Islanders (NHPI) (9.3%). The 2012 arthroplasty utilization rates for Asian, White, and NHPI increased by 32.5%, 11.2%, and 86.5%, respectively, by 2019. Compared to Asians, Whites more often underwent hip arthroplasty compared to knee arthroplasty (odds ratio (OR) 1.755; p < 0.001). Compared to Asians, Whites and NHPI more often received total knee compared to unicompartmental knee arthroplasty (White: OR 1.499; NHPI: OR 2.013; p < 0.001). White patients had longer hospitalizations (2.66 days) compared to Asians (2.19 days) (p = 0.005) following bilateral procedures. Medicare was the most common insurance for Asians (66.2%) and Whites (54.2%) while private insurance was most common for NHPI (49.4%). Compared to Asians, economic status was higher for Whites (White OR 0.695; p < 0.001) but lower for NHPI (OR 1.456; p < 0.001). After controlling for bilateral procedures, NHPI had a lower risk of transfusion compared to Asians (OR 0.478; p < 0.001) and Whites had increased risk of wound or systemic complications compared to Asians (OR 2.086; p = 0.045).

Conclusions

Despite NHPI demonstrating a significantly poorer health profile and lower socioeconomic status, contrary to previous literature involving minority racial groups, no significant overall differences in arthroplasty utilization rates or perioperative complications could be demonstrated amongst the racial groups examined.

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Data availability

Data for this study is kept in a secure repository and can be accessed with permission for appropriate requests.

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Acknowledgements

The authors would like to thank Samantha N. Andrews PhD, ATC, for her contributions regarding statistical analysis and help with student mentoring and manuscript preparation

Funding

This research received no specific grant from any funding agency in the public, commercial or non-for-profit sectors.

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Authors and Affiliations

  1. John A Burns School of Medicine, University of Hawai’i at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA

    Tyler Thorne, Scott Nishioka, Krystin Wong, Dylan R. Y. Lawton & Cass K. Nakasone

  2. Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA

    Sian Yik Lim & Cass K. Nakasone

Authors
  1. Tyler Thorne
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  2. Scott Nishioka
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  3. Krystin Wong
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  4. Dylan R. Y. Lawton
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  6. Cass K. Nakasone
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Contributions

Conceptualization: Cass K. Nakasone. Methodology: Cass K. Nakasone. Formal statistical analysis: Samantha Andrews. Writing—original draft preparation: Tyler Thorne, Cass K. Nakasone. Writing—reviewing and editing: Tyler Thorne, Sian Lik Yim, Cass K. Nakasone. Data Acquisition, Management and Preparation for Statistical Analysis—Scott Nishioka, Krystin Wong, Dylan Lawton. Supervision—Cass K. Nakasone. Project administration—Samantha Andrews, Cass K. Nakasone.

Corresponding author

Correspondence to Cass K. Nakasone.

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Conflict of interest

Author Cass K. Nakasone is a consultant and receives royalties from Ortho Development Inc. but not related to the subject matter discussed in this manuscript. All other authors certify that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Hawai’i Pacific Health Research Institute (local Western Institutional Review Board) approved this study.

Informed consent

This was a retrospective chart review and data collected were deidentified and presented as large scale, aggregate data. Therefore, no informed consent was obtained or required by the IRB.

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Thorne, T., Nishioka, S., Wong, K. et al. Examining racial disparities in utilization rate and perioperative outcomes following knee and hip arthroplasty. Arch Orthop Trauma Surg (2024). https://doi.org/10.1007/s00402-024-05272-y

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