Racial Disparities in Revision Total Knee Arthroplasty: Analysis of 125,901 Patients in National US Private Payer Database
There is a relative paucity of studies that characterized racial disparities in revision total knee arthroplasty (TKA). Therefore, this study was specifically conducted to evaluate the following: (1) incidence; (2) annual burden; (3) causes; and (4) age group distribution of revision TKA among different racial groups in the US sample population.
The PearlDiver database was utilized to identify patients with knee osteoarthritis (OA) who underwent primary then subsequent revision TKA from January 2007 to December 2014. Patients were stratified by race, and subset stratification by age was also performed. In each racial cohort, the overall incidence of revision TKA, annual revision burdens, and causes of revisions were calculated and compared. Additionally, a sub-analysis for the incidence of revision TKA stratified by age, in each cohort, was performed. Statistical analysis was performed to demonstrate revision incidence, burden, causes, and age distribution.
Revision incidence and burden were the highest in the African-American cohort (12.4%, 11.1%), (p < 0.001) and was lowest in the Asian cohort (3.4%, 3.3%) (p < 0.001). Across all cohorts, mechanical complications of the joint prosthesis were the most common cause of revision followed by periprosthetic joint infection, while contracture was the least common (p < 0.001). Subset analysis by age revealed that the highest incidence of revision TKA was in patients less than 40 years old in the Caucasian cohort (27.1%). The African-American (17.8%), other races (7.9%), and Hispanic (16.5%) cohorts had the highest incidence of revision in the 40 to 64 years age range. Among the Asian (4.1%) and Native American (9.7%) cohorts, revision incidence was highest in patients older than 65 years.
The present study demonstrated that racial disparities, highlighted by previous studies mainly in primary TKA, extend to influence revision TKA. Among the studied racial cohorts, race may affect outcomes and our results will help expand the current literature particularly on its role in revision TKA.
KeywordsRace Ethnic Knee Total knee arthroplasty Replacement Revision
Compliance with Ethical Standards
Conflicts of Interest
Martin Roche declares the following conflicts: Mako-stryker: paid consultant; Mako-stryker, Orthosensor: IP royalties; Mako-stryker, Orthosensor: paid presenter or speaker; Mako surgical-stryker: research support; Orthosensor: paid consultant; and Orthosensor, Cayenne: stock or stock options. Michael Mont declares the following conflicts: AAOS: board or committee member; Cymedica: paid consultant; DJ Orthopedics: paid consultant, research support; Johnson & Johnson: paid consultant, research support; Journal of Arthroplasty: editorial or governing board; Journal of Knee Surgery: editorial or governing board; Microport: IP royalties; National Institutes of Health (NIAMS & NICHD): research support; Ongoing Care Solutions: paid consultant, research support; Orthopedics: editorial or governing board; Orthosensor: paid consultant, research support; Pacira: paid consultant; Peerwell: stock or stock options; Performance Dynamics Inc.: paid consultant; Reflexion: paid consultant; Sage: paid consultant; Stryker: IP royalties, paid consultant, research support; Surgical Techniques International: editorial or governing board; and TissueGene: paid consultant, research support. All the rest of the authors declare that they have no conflict of interest.
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