Persistence of Racial and Ethnic Differences in Utilization and Adverse Outcomes of Total Joint Replacement

Abstract

Nonwhite individuals from minority groups are less likely than their white counterparts to undergo total knee replacement, and minority patients who undergo total knee replacement are more likely to have the procedure in a low-volume hospital and to die or experience a complication in the perioperative period. Twenty years after these findings were reported in population-based samples1, Zhang et al. provide evidence in this issue of The Journal of Bone & Joint Surgery that these disparities in utilization persist and that minority patients remain more likely to have total knee replacement in low-volume centers, where outcomes are worse2. The authors also document that Native Americans are 6 times more likely than whites to die during total knee replacement admission. The study takes advantage of U.S. state databases that include all payers, an advance over investigations limited to the Medicare population (virtually all of whom are ≥65 years old)3. This is particularly important, as recent studies have noted that the largest increase in the rate of total knee replacement is occurring among those younger than 65 years4. Still, as Zhang et al. noted thoughtfully, their study has limitations that we should appreciate. First, their denominator for utilization rates is not persons with advanced arthritis (the population eligible for total knee replacement) but rather the general population. This approach assumes that the prevalence of …