Black patients had higher risk of aseptic, septic revision TKR vs white patients
Published results showed a significantly higher risk of aseptic revision total knee replacement and, to a lesser extent, septic revision TKR among Black patients compared with white patients.
Anne R. Bass, MD, and colleagues analyzed data of 722,492 patients who underwent TKR between 2004 and 2014 from statewide databases from California, Florida and New York. Researchers used Cox proportional hazards regression modeling to measure the association of race with septic and aseptic revision TKR. Researchers also included patient age, sex, insurance, comorbidities, joint-specific diagnoses, surgical complications during index TKR, any infection during index TKR admission, hospital type, bed size and the annual TKR volume of the hospital as covariates, which have been linked to revision TKR risk in the literature.
Overall, 8.46% of the patient population were Black and 61.68% were women. Results showed Black patients had a higher risk of septic and aseptic revision TKR vs. white patients. Researchers found diabetes, obesity, kidney disease, chronic obstructive pulmonary disease, inflammatory arthritis, surgical site complications during index TKR, Medicaid insurance and low annual TKR volume at the hospital where the index TKR was performed were other risk factors for septic revision TKR. Male sex, workers’ compensation insurance and low hospital TKR volume were risk factors for aseptic revision TKR, according to results. Researchers noted the risk of aseptic TKR revision was lower among patients with obesity. An analysis within each category of hospital TKR volume showed a hazard ratio of 1.20 at very low-volume hospitals compared with 1.68 at very high-volume hospitals for aseptic revision among Black vs. white patients.
“Racial disparities in revision TKR are greater for aseptic than for septic revision. Racial disparities in aseptic revision risk are highest at high TKR volume hospitals,” Bass, who is a rheumatologist at Hospital for Special Surgery, told Healio Orthopedics. “The reason for this is unknown, but possibilities include Black patients undergoing TKR at high volume hospitals with more advanced joint deformity than white patients, or to disparities in care delivery models within hospitals.”