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Racial Disparities in Revision Total Knee Arthroplasty: Analysis of 125,901 Patients in National US Private Payer Database

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Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

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References

  1. Kane RL, Saleh KJ, Wilt TJ, Bershadsky B. The functional outcomes of total knee arthroplasty. J Bone Joint Surg. 2005;87(8):1719–24.

    PubMed  Google Scholar 

  2. Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster J-Y. Health-related quality of life in total hip and total knee arthroplasty. J Bone Joint Surg. 2004;86(5):963–74.

    Article  PubMed  Google Scholar 

  3. Pulido L, Parvizi J, Macgibeny M, et al. In hospital complications after total joint arthroplasty. J Arthroplast. 2008;23(6 Suppl 1):139–45.

    Article  Google Scholar 

  4. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780–5.

    PubMed  Google Scholar 

  5. Ong KL, Mowat FS, Chan N, Lau E, Halpern MT, Kurtz SM. Economic burden of revision hip and knee arthroplasty in Medicare enrollees. Clin Orthop Relat Res. 2006;446:22–8.

    Article  CAS  PubMed  Google Scholar 

  6. Oduwole K, Molony D, Walls R, Bashir S, Mulhall K. Increasing financial burden of revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2010;18(7):945–8.

    Article  PubMed  Google Scholar 

  7. Kremers HM, Visscher SL, Kremers WK, Naessens JM, Lewallen DG. The effect of obesity on direct medical costs in total knee arthroplasty. J Bone Joint Surg. 2014;96(9):718–24.

    Article  PubMed  Google Scholar 

  8. Nwachukwu BU, Kenny AD, Losina E, Chibnik LB, Katz JN. Complications for racial and ethnic minority groups after total hip and knee replacement. J Bone Joint Surg. 2010;92(2):338–45.

    Article  PubMed  Google Scholar 

  9. Mortazavi SMJ, Schwartzenberger J, Austin MS, Purtill JJ, Parvizi J. Revision total knee arthroplasty infection: incidence and predictors. Clin Orthop Relat Res. 2010;468(8):2052–9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Schairer WW, Vail TP, Bozic KJ. What are the rates and causes of hospital readmission after total knee arthroplasty? Clin Orthop Relat Res. 2014;472(1):181–7.

    Article  PubMed  Google Scholar 

  11. Racial disparities in total knee replacement among Medicare enrollees—United States, 2000-2006. MMWR Morb Mortal Wkly Rep. 2009;58(6):133–38.

  12. Figaro MK, Williams-Russo P, Allegrante JP. Expectation and outlook: the impact of patient preference on arthritis care among African Americans. J Ambul Care Manage. 2005;28(1):41–8.

    Article  PubMed  Google Scholar 

  13. Lavernia CJ, Alcerro JC, Rossi MD. Fear in arthroplasty surgery: the role of race. Clin Orthop Relat Res. 2010;468(2):547–54.

    Article  PubMed  Google Scholar 

  14. Skinner J, Zhou W, Weinstein J. The influence of income and race on total knee arthroplasty in the United States. J Bone Joint Surg. 2006;88(10):2159–66.

    PubMed  Google Scholar 

  15. Hanchate DA, Zhang TY, Felson SD, Ash SA. Exploring the determinants of racial and ethnic disparities in total knee arthroplasty: health insurance, income, and assets. Med Care. 2008;46(5):481–8.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Irgit K, Nelson CL. Defining racial and ethnic disparities in THA and TKA. Clin Orthop Relat Res. 2011;469(7):1817–23.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg. 2005;87(7):1487–97.

    PubMed  Google Scholar 

  18. Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR. Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991–2010. JAMA. 2012;308(12):1227–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Blum MA, Singh JA, Lee G-C, Richardson D, Chen W, Ibrahim SA. Patient race and surgical outcomes after total knee arthroplasty: an analysis of a large regional database. Arthritis Care Res. 2013;65(3):414–20.

    Article  Google Scholar 

  20. Dy CJ, Marx RG, Bozic KJ, Pan TJ, Padgett DE, Lyman S. Risk factors for revision within 10 years of total knee arthroplasty. Clin Orthop Relat Res. 2014;472(4):1198–207.

    Article  PubMed  Google Scholar 

  21. Springer BD, Odum SM, Nagpal VS, et al. Is socioeconomic status a risk factor for stiffness after total knee arthroplasty? A multicenter case-control study. Orthop Clin N Am. 2012;43(5):e1–7.

    Article  Google Scholar 

  22. Kasahara Y, Majima T, Kimura S, Nishiike O, Uchida J. What are the causes of revision total knee arthroplasty in Japan? Clin Orthop Relat Res. 2013;471(5):1533–8.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Koh IJ, Kim TK, Chang CB, Cho HJ, In Y. Trends in use of total knee arthroplasty in Korea from 2001 to 2010. Clin Orthop Relat Res. 2013;471(5):1441–50.

    Article  PubMed  Google Scholar 

  24. Koh IJ, Cho WS, Choi NY, Kim TK. Causes, risk factors, and trends in failures after TKA in Korea over the past 5 years: a multicenter study. Clin Orthop Relat Res. 2014;472(1):316–26.

    Article  PubMed  Google Scholar 

  25. Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010;468(1):45–51.

    Article  PubMed  Google Scholar 

  26. Namba RS, Cafri G, Khatod M, Inacio MCS, Brox TW, Paxton EW. Risk factors for total knee arthroplasty aseptic revision. J Arthroplast. 2013;28(8, Supplement):122–7.

    Article  Google Scholar 

  27. Hosaka K, Saito S, Ishii T, Mori S, Sumino T, Tokuhashi Y. Asian-specific total knee system: 5−14 year follow-up study. BMC Musculoskelet Disord. 2011;12:251.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Chaichankul C, Tanavalee A, Itiravivong P. Anthropometric measurements of knee joints in Thai population: correlation to the sizing of current knee prostheses. Knee. 2011;18(1):5–10.

    Article  PubMed  Google Scholar 

  29. Cheng FB, Ji XF, Lai Y, Feng JC, Zheng WX, Sun YF, et al. Three dimensional morphometry of the knee to design the total knee arthroplasty for Chinese population. Knee. 2009;16(5):341–7.

    Article  PubMed  Google Scholar 

  30. Urabe K, Miura H, Kuwano T, Matsuda S, Nagamine R, Sakai S, et al. Comparison between the shape of resected femoral sections and femoral prostheses used in total knee arthroplasty in Japanese patients: simulation using three-dimensional computed tomography. J Knee Surg. 2003;16(1):27–33.

    PubMed  Google Scholar 

  31. Tang Q, Zhou Y, Yang D, Xu H, Liu Q. The offset of the tibial shaft from the tibial plateau in Chinese people. J Bone Joint Surg. 2010;92(10):1981–7.

    Article  PubMed  Google Scholar 

  32. Perfetti DC, Boylan MR, Naziri Q, Khanuja HS, Urban WP. Does sickle cell disease increase risk of adverse outcomes following total hip and knee arthroplasty? A Nationwide Database Study. J Arthroplast. 2015;30(4):547–51.

    Article  Google Scholar 

  33. 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(12):2107–15.

    Article  PubMed  Google Scholar 

  34. Kurtz S, Lau E, Ong K, Zhao K, Kelly M, Bozic K. Future young patient demand for primary and revision joint replacement: National Projections from 2010 to 2030. Clin Orthop Relat Res. 2009;467(10):2606–12.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kim KT, Lee S, Ko DO, Seo BS, Jung WS, Chang BK. Causes of failure after total knee arthroplasty in osteoarthritis patients 55 years of age or younger. Knee Surg Relat Res. 2014;26(1):13–9.

    Article  PubMed  PubMed Central  Google Scholar 

  36. W-Dahl A, Robertsson O, Lidgren L. Surgery for knee osteoarthritis in younger patients. Acta Orthop. 2010;81(2):161–4.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Rand JA, Trousdale RT, Ilstrup DM, Harmsen WS. Factors affecting the durability of primary total knee prostheses. J Bone Joint Surg Am. 2003;85-a(2):259–65.

    Article  Google Scholar 

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Authors and Affiliations

  1. Holy Cross Orthopedic Institute, 5597 North Dixie Highway, Fort Lauderdale, FL, USA

    Martin Roche, Tsun yee Law, Sam Rosas, Jennifer Kurowicki & Kevin Wang

  2. Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue/A40, Cleveland, OH, 44195, USA

    Assem A. Sultan, Erica Umpierrez, Anton Khlopas & Michael A. Mont

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  1. Martin Roche
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Correspondence to Michael A. Mont.

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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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Roche, M., Law, T.y., Sultan, A.A. et al. Racial Disparities in Revision Total Knee Arthroplasty: Analysis of 125,901 Patients in National US Private Payer Database. J. Racial and Ethnic Health Disparities 6, 101–109 (2019). https://doi.org/10.1007/s40615-018-0504-z

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  • DOI: https://doi.org/10.1007/s40615-018-0504-z

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