KS25: ETHNICITY AFFECTS THE OUTCOME OF TOTAL KNEE ARTHROPLASTY

Abstract

Introduction: There is an increasing appreciation of the potential impact of ethnic and gender diversity on access to healthcare. Previous studies have shown that both race and gender are important confounding factors. In this study we isolate the influence of ethnicity on the functional outcome of total knee replacement by examining outcomes in female patients.

Materials and Methods: We reviewed a data-base of 412 female patients (518 knees) who had undergone primary TKA performed by a single surgeon between 1990 and 2008. Eighty-seven of these patients (25 African-American, 23 Hispanic and 26 Caucasian patients) were case-matched for age and BMI at the time of surgery. The average patient age was 67.0 years with a BMI of 32.0. The groups showed no statistical different in age (p=0.99) or BMI (p=0.90). Preoperative and postoperative Knee Society scores were available on all patients in addition to marital status. Outcome measures of all three groups were compared using ANOVA statistical methods with post hoc analysis.

Results: Post-op Knee Society Scores were Significantly lower in the African-American patients (76.2, p=0.02) than the Hispanic (85.1) and Caucasian (87.9) groups. There was also a Significant difference in post-op pain scores for African-American, Hispanic, and Caucasian patients were 32.2, 40.3, and 42.8 respectively, (p=0.02) showing a statistically Significant difference between groups. The average Function Score was also lower in both African-American (61.1) and Hispanic (63.3) groups when compared to Caucasian (72.1) but this difference was not statistically Significant (p=0.09, p=0.25). There was no Significant difference in preoperative knee scores, post-op ROM or stability, or marital status among the three groups (p > .05).

Discussion:

• Within the female population, ethnicity was shown to have a Significant influence on the outcome of TKA as inferior results were reported by both Hispanic and African-American patients when compared to Caucasians. This effect is particularly marked in African-American women whose Knee Society Scores were 13% lower at follow-up compared to Caucasians.

• The differences in the perception of pain noted by the various ethnic groups proved to be a principal factor for outcomes following TKA among women.

• This study demonstrates that the ethnicity must be considered in assessing outcomes. Within the female population TKA appears to be less successful in Hispanic and African-American patients.