January 09, 2018
2 min read

Black patients less likely to receive knee replacement, despite worse symptoms

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Lindsey A. MacFarlane

Despite exhibiting worse pain and function at baseline, black patients are less likely to receive total knee replacement than white patients, underscoring ongoing racial disparities in the use of knee replacement surgery, according to findings published in the Journal of Clinical Rheumatology.

“Prior studies have demonstrated racial disparities in the receipt of total joint replacement,” Lindsey A. MacFarlane, MD, MPH, of Brigham and Women’s Hospital, in Boston, told Healio Rheumatology. “The current results demonstrate that this disparity persists. Some of the initial data used to investigate this disparity were collected in the 1990s. Nearly 30 years later, our findings suggest that the rates of total knee replacement continue to be strikingly and significantly lower among black than white people.”

To evaluate the racial disparity in total knee replacement procedures, the researchers analyzed data from the Vitamin D and Omega-3 Trial (VITAL), a nationwide, randomized, controlled study including 25,874 adults, of whom 20% were black. From the group, the researchers identified participants who likely experienced knee osteoarthritis, based on reported pain severity, physician diagnosis and whether they could walk two to three blocks without pain. In total, 1,070 VITAL participants met the inclusion criteria.

Participants completed a modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, and then reported whether they had received total knee replacement during annual follow-up appointments. The researchers then evaluated the association between race and total knee replacement using Cox regression, after adjusting for demographic and socioeconomic information, as well as comorbidities and WOMAC data.

According to the researchers, black patients reported worse pain (P < .001) and worse function (P < .001), based on WOMAC data. By the end of the 3.6 year median follow-up period, 180 participants underwent total knee replacement, including 11% of black participants and 19% of white participants (HR = 0.51; 95% CI, 0.32-0.81). The researchers observed lower use of total knee replacement among black patients across all income and education levels.

“Our key takeaway is that in a cohort of individuals with likely knee osteoarthritis, blacks were approximately 50% less likely to have a total knee replacement, despite reporting greater knee pain than whites,” MacFarlane said. “The drivers of this disparity may be multifactorial, including patient preference and features of and access to our health care system and orthopedic surgery, in particular. Further research is warranted to better understand the underpinnings of this disparity and to provide targeted programs to close this divide.” – by Jason Laday

Disclosure: The researchers report funding from the NIH.