Skip to main content

Advertisement

SpringerLink
Log in

Total Versus Unicondylar Knee Arthroplasty: Does Race Play a Role in the Treatment Selection?

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Introduction

Racial disparities have been well reported in the utilization and outcomes of knee arthroplasty, but it is unclear whether disparities also extend to the choice of surgical treatment. The primary objective of this study is to identify if race plays a role in the selection of unicondylar versus total knee arthroplasty (UKA, TKA) for isolated tibiofemoral osteoarthritis (OA). A secondary objective is to identify the differences in the complication rates for each procedure by racial identity.

Methods

A retrospective review of the 2006–2018 American College of Surgeons National Surgical Quality Improvement Program was performed. Asian, Black, Hawaiian/Pacific Islander, Hispanic, Native American/Alaskan, and White individuals who underwent primary elective UKA or TKA were compared in terms of UKA vs. TKA utilization rates and outcomes.

Results

A total of 308,715 patients were analyzed. After controlling for all baseline differences, Whites (3.5%), Asians (3.7%), and Hawaiian/Pacific Islanders (3.1%) had around twice the rate of UKA compared to Blacks (1.6%), while Hispanics (2.1%) and Native American/Alaskans (1.7%) were in between (p <0.001). TKA was associated with higher complications compared to UKA in all racial groups (p < 0.001).

Conclusion

Minority patients, especially Blacks, were less likely to receive UKA for treatment of isolated knee OA. This is significant because treatment selection in patients who are eligible for UKA can have a significant impact on postoperative recovery and complications rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino A, Mont MA. Knee osteoarthritis: a primer. Perm J [Internet]. 2017; [cited 2021 23];21. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5638628/.

  2. Stoddart JC, Dandridge O, Garner A, Cobb J, van ARJ. The compartmental distribution of knee osteoarthritis – a systematic review and meta-analysis. In: Osteoarthritis Cartilage [Internet]: Elsevier; 2020. [cited 2021 Mar 7];0. Available from: https://www.oarsijournal.com/article/S1063-4584(20)31197-3/abstract.

  3. Beard DJ, Davies LJ, Cook JA, MacLennan G, Price A, Kent S, et al. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. The Lancet Elsevier. 2019;394:746–56.

    Article  Google Scholar 

  4. Liddle AD, Judge A, Pandit H, Murray DW. Adverse outcomes after total and unicompartmental knee replacement in 101,330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet Lond Engl. 2014;384:1437–45.

    Article  Google Scholar 

  5. Hansen EN, Ong KL, Lau E, Kurtz SM, Lonner JH. Unicondylar knee arthroplasty has fewer complications but higher revision rates than total knee arthroplasty in a study of large United States Databases. J Arthroplasty Elsevier. 2019;34:1617–25.

    Article  Google Scholar 

  6. Wilson HA, Middleton R, Abram SGF, Smith S, Alvand A, Jackson WF, et al. Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. The BMJ [Internet]. 2019; [cited 2021 Feb 23];364. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383371/.

  7. Jordan JM. An ongoing assessment of osteoarthritis in African Americans and Caucasians in North Carolina: the Johnston County Osteoarthritis Project. Trans Am Clin Climatol Assoc. 2015;126:77–86.

    PubMed  PubMed Central  Google Scholar 

  8. Martin JR, Jennings JM, Dennis DA. Morbid obesity and total knee arthroplasty: a growing problem. J Am Acad Orthop Surg. 2017;25:188–94.

    Article  Google Scholar 

  9. Rudasill SE, Dattilo JR, Liu J, Kamath AF. Hemiarthroplasty or total hip arthroplasty: is there a racial bias in treatment selection for femoral neck fractures? Geriatr Orthop Surg Rehabil. 2019;10:2151459319841741.

    Article  Google Scholar 

  10. Singh JA, Lu X, Rosenthal GE, Ibrahim S, Cram P. Racial disparities in knee and hip total joint arthroplasty: an 18-year analysis of national Medicare data. Ann Rheum Dis. 2014;73:2107–15.

    Article  Google Scholar 

  11. Shahid H, Singh JA. Racial/ethnic disparity in rates and outcomes of total joint arthroplasty. Curr Rheumatol Rep. 2016;18:20.

    Article  Google Scholar 

  12. Stone AH, MacDonald JH, Joshi MS, King PJ. Differences in perioperative outcomes and complications between African American and White patients after total joint arthroplasty. J Arthroplast. 2019;34:656–62.

    Article  Google Scholar 

  13. Sheth M, Chambers M, Gronbeck C, Harrington MA, Halawi MJ. Total hip arthroplasty in Black/African American patients: an updated nationwide analysis. J Racial Ethn Health Disparities. 2021;8:698–703.

    Article  Google Scholar 

  14. Ezomo OT, Sun D, Gronbeck C, Harrington MA, Halawi MJ. Where do we stand today on racial and ethnic health disparities? An analysis of primary total hip arthroplasty from a 2011–2017 National Database. Arthroplasty Today. 2020;6:872–6.

    Article  Google Scholar 

  15. Venugopal V, Gronbeck C, Harvey L, Patel AP, Harrington MA, Halawi MJ. Time trends in perioperative characteristics and health outcomes in Hispanic patients undergoing primary total knee arthroplasty. J Racial Ethn Health Disparities [Internet]. 2020 [cited 2021 May 8]; Available from. https://doi.org/10.1007/s40615-020-00910-8.

  16. Trivedi A, Ezomo OT, Gronbeck C, Harrington MA, Halawi MJ. Time trends and risk factors for 30-day adverse events in Black patients undergoing primary total knee arthroplasty. J Arthroplasty Elsevier. 2020;35:3145–9.

    Article  Google Scholar 

  17. The AJRR Annual Report [Internet]. [cited 2021 Jun 27]. Available from: https://www.aaos.org/registries/publications/ajrr-annual-report/

Download references

Author information

Authors and Affiliations

  1. Frank H Netter MD School of Medicine at Quinnipiac University, Hamden, CT, USA

    Anya Kamaraju, Richard Feinn & Karen Myrick

  2. University of Saint Joseph, Hartford, West, CT, USA

    Karen Myrick

  3. Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA

    Mohamad J. Halawi

Authors
  1. Anya Kamaraju
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard Feinn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karen Myrick
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamad J. Halawi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohamad J. Halawi.

Ethics declarations

Ethics Approval

The study was exempt from IRB review.

Consent to Participate/for Publication

Not applicable

Competing Interests

Ms. Kamaraju, Dr. Myrick, and Dr. Feinn do not have any conflicts of interest to declare. Dr. Halawi is a member of the editorial board at the Journal or Bone and Joint Surgery.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(DOCX 76 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kamaraju, A., Feinn, R., Myrick, K. et al. Total Versus Unicondylar Knee Arthroplasty: Does Race Play a Role in the Treatment Selection?. J. Racial and Ethnic Health Disparities 9, 1845–1849 (2022). https://doi.org/10.1007/s40615-021-01120-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-021-01120-6

Keywords

Search

Navigation