Black, Hispanic Patients Have More Complications After Revision for Arthroplasty Failure

Black and Hispanic patients who undergo revision surgery following failed total joint arthroplasty (TJA) are more likely to have complications compared to White patients, according to a study.

“Racial and ethnic disparities in access to hip and knee total joint arthroplasty (TJA) and postoperative outcomes have wide-reaching implications for patients and the health care system,” the researchers explained.

A retrospective analysis was performed at a single institution, where 4,424 consecutive revision TJA patients were assessed. The researchers implemented student’s t-test and chi-squared analysis to compared differences in patient demographics and clinical outcomes between patients by race (White, Black, Hispanic, and Asian).

Black patients, compared to White patients, had a significantly higher body mass index (BMI) (P=0.04), American Society of Anesthesiologists (ASA) score (P=0.04), and rates of postoperative infection (P=0.04), as well as longer hospital length of stay (LOS) (P=0.06). Hispanic patients, compare to White patients, had a significantly higher BMI (P=0.04) and risk for postoperative infection (P<0.01). Black patients had a significantly higher ASA score (P=0.02, P=0.03) compared to Hispanic and Asian patients, as well as a significantly longer LOS (P=0.01) and postoperative infection risk (P=0.02).

The study was published in The Journal of Arthroplasty.

“The study findings demonstrate an underutilization of revision TJA by ethnic minority groups, suggesting that disparities in access to orthopedic surgery increase from primary to revision surgery despite higher failure rates of minority ethnic groups reported after primary TJA surgery. In addition, inferior postoperative outcomes were associated with African Americans and Hispanics, when compared to white patients, with African Americans demonstrating the highest risk of postoperative complications,” the study authors concluded.

Studies have also linked minority race to poorer total knee arthroplasty (TKA) outcomes. The researchers of this study ultimately concluded that, “Racial and ethnic disparities remain a public health challenge for patients undergoing TKA. While initiatives aimed at improving preoperative disease-burden and comorbidity profiles represent an important step, they alone are insufficient to fully account for or eliminate the disparities in TKA outcomes,” the researchers concluded.