Minorities Less Likely to Undergo TKA, More Likely to Have Complications

    Minority populations have lower rates of total knee arthroplasty (TKA) utilization but higher rates of adverse health outcomes associated with the procedure, according to a study published in The Journal of Bone and Joint Surgery.

    More than 600,000 knee replacements are performed each year in the United States, according to the Agency for Healthcare Research and Quality (AHRQ). The number of TKAs has more than doubled, from 329,000 in 1997 to 719,000 in 2010.

    This AHRQ-funded study examined 4 outcome variables:

    • Rate of THA
    • Use of high-volume hospitals
    • In-hospital mortality
    • In-hospital complications

    Patient race was categorized by the State Inpatient Databases (SID) as white, black, Hispanic, Asian, Native American, and mixed race.

    The study analyzed data from 8 years (2001-2008) and 8 racially diverse states (Arizona, Colorado, Iowa, North Carolina, New Jersey, Rhode Island, Wisconsin, and Florida) in the SID, identifying a total of 547,380 admissions for TKA.

    The 3 largest ethnic groups were whites (87.24%), blacks (5.88%), and Hispanics (4.20%), and the 3 smallest were Asians (0.46%), Native Americans (0.51%), and mixed race (1.71%).

    Patient characteristics included age, sex, admission source (routine and non-routine), insurance type (Medicare, Medicaid, private, and other), surgical reason, length of hospital stay, and year of surgery, among others. The study excluded patients under age 45 and patients who had undergone TKA for a congenital dislocation, infection, or a neoplasm.

    Among the results:

    • In comparison with the white population, minorities had lower rates of TKA utilization.
    • Minorities were less likely to undergo TKA at high-volume hospitals.
    • The risk for in-hospital mortality and the complication rate following TKA were significantly higher for blacks, Native Americans, and mixed-race individuals.

    “Even after adjusting for certain patient demographics, socioeconomic status, and healthcare system characteristics, significant racial disparities in TKA utilization and outcomes exist,” said Yan Ma, PhD, corresponding author of this study and associate professor in the Milken Institute School of Public Health at George Washington University.

    “These findings create an opportunity for health care providers to consider differences in utilization and outcomes that may result directly from their referral patterns.”


    Zhang W, Lyman S, Boutin-Foster C, et al. Racial and ethnic disparities in utilization rate, hospital volume, and perioperative outcomes after total knee arthroplasty. J Bone Joint Surg Am. 2016 Aug 3;98(15):1243-52. doi: 10.2106/JBJS.15.01009.