Utilization of bilateral TKA lower among African American vs white patients
Although African American patients experienced low in-hospital complication rates after bilateral total knee arthroplasty, published results showed a lower utilization of bilateral TKA among these patients compared with white patients.
Bella Mehta, MBBS, MS, and colleagues computed differences in temporal trends in utilization and major in-hospital complication rates of bilateral TKA vs. unilateral TKA between African American and white patients from 2007 to 2016. Researchers assessed racial differences in trends adjusted for individual-, hospital- and community-level variables using multivariable logistic regression models.
During the time period studied, researchers identified an estimated 276,194 bilateral TKAs and 5,528,429 unilateral TKAs performed in the United States. Results showed a decline in the proportion of bilateral TKA among all TKAs from 5.53% in 2007 to 2008 to 4.03% in 2015 to 2016. Researchers noted a significant decline in bilateral TKA utilization compared with unilateral TKA after adjusting for individual-, ecological- and hospital-level variables.
During the study period, researchers found 95% of white patients and 96% of African American patients underwent unilateral TKA, while 5% of white patients and 3.9% of African American patients underwent bilateral TKA.
“For a select group of patients, [bilateral TKA] is a useful and cost-effective procedure. And what we can see is that African Americans are not getting access to it, and there could be many reasons for that,” Mehta, of Hospital for Special Surgery and Weill Cornell Medicine, told Healio Orthopedics. “Maybe African Americans are choosing not to do this procedure, maybe they’re not offered the procedure or maybe there are other factors that play into this decision.”
However, when adjusted for individual-, ecological- and hospital-level variables, Mehta noted African American patients still had low utilization of bilateral TKA compared with white patients. She added that, although complication rates in bilateral TKA tend to be higher among African American patients, adjusted results showed African American patients had low in-hospital complication rates after bilateral TKA, but high in-hospital complication rates after unilateral TKA.
“There is no [obvious] reason that we can see why these patients are not having utilization of bilateral knee replacements, and we need to look into it closely on a health policy level of what needs to be changed in all of this,” Mehta said.
In the future, Mehta and colleagues plan to assess whether insurance type has an influence on utilization of unilateral or bilateral TKA among patients.
“Maybe they have more Medicaid and Medicare, and maybe there are reimbursement issues and that is why there is such a vast difference in why ‘X’ person gets [bilateral TKA] and ‘Y’ person doesn’t,” Mehta said.