Race, Poverty Not Tied to Knee Replacement Outcomes

Low surgeon volume and low pre-op expectations for improvement tied to higher risk of failure

THURSDAY, Nov. 7, 2019 (HealthDay News) -- Race and poverty are not significantly tied to total knee replacement (TKR) failure or revision, according to a study published in the November issue of Arthritis Care & Research.

Anne R. Bass, M.D., from the the Hospital for Special Surgery in New York City, and colleagues used a single-institution TKR registry (Jan. 1, 2008, to Feb. 6, 2012) to identify patients who underwent primary unilateral TKR (4,062 patients). Patient data were linked to the New York Statewide Planning and Research Cooperative System database (2008 through 2014) to capture revisions performed at outside institutions.

Patients had a mean age of 68.4 years, 64 percent were female, 8 percent lived in census tracts with >20 percent of the population under the poverty line, and 9 percent were black. Median follow-up time was 5.3 years. The researchers found that overall, 3 percent of patients required revision a median 454 days after surgery. Compared to white patients, TKR revision risk was higher in black patients (hazard ratio, 1.69). However, only younger age, male sex, and constrained prosthesis were predictors of TKR revision in multivariable analysis. Based on two-year surveys, TKR failure occurred in 7 percent of patients. Risk of TKR failure was associated with nonosteoarthritis TKR indication, low surgeon volume, and low Hospital for Special Surgery Expectations Survey score. There was no association noted between community poverty and either TKR revision or failure.

"In patients undergoing surgery at a high-volume hospital, community poverty does not increase the risk of TKR revision or failure in blacks or whites," the authors write.

Two of the authors disclosed receiving consulting fees from pharmaceutical and medical device companies.

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