Racial and socioeconomic factors linked to increased revision risk after knee replacement

November 07, 2015

Although complication and mortality rates following knee replacement surgery have decreased in recent years, 4% of patients receiving the procedure require a revision surgery on the same knee within five years. A new study by a group at Hospital for Special Surgery (HSS) reveals that blacks in the U.S. are at a significantly higher risk of requiring a revision than American whites, and that socioeconomic factors may play an important role in revision risk. The findings could allow clinicians to better predict which patients are more prone to surgical complications and to more effectively counsel their patients.

To conduct the work, the researchers reviewed over 4,000 titles, 106 abstracts, and 24 papers, ultimately identifying four studies from which they could analyze knee replacement revision rates based on race. They found that risk of revision was 38% higher in blacks than whites in the U.S., findings that will be presented on November 9 at the American College of Rheumatology Annual Meeting in San Francisco.

"We know that blacks are less likely to undergo knee replacement surgery than whites, which could be due to a perception that they're at increased risk of complications," explains senior study author Anne R. Bass, MD, Associate Attending Physician and Program Director of the HSS Rheumatology Fellowship Program.

It's been shown that if blacks are candidates for surgery, meaning they have enough pain and x-ray evidence of severe disease, doctors recommend surgery to them at the same rates as whites. "Therefore it's not an issue of the physician not recommending the surgery, it's an issue of the patients' declining the surgery," says Bass. When U.S. blacks do undergo knee replacement surgery they tend to have more advanced disease and this may be part of the reason they are more prone to complications such as revision.

Bass and her colleagues also looked at three studies that analyzed the same sample of Medicare patients who had undergone a knee replacement. They found that one study hadn't controlled for whether patients qualified for Medicaid or not - a marker of low socioeconomic status. This study made it look like the risk of revision associated with being black was higher than it really was and pointed out the importance of controlling for socioeconomic factors.

"In the end we did find that there was a higher rate of revision among blacks even when socioeconomic status was controlled for," says Dr. Bass, "but we also found that socioeconomic status is clearly an important confounder when analyzing revision risk."

"Black patients may be more likely to have known someone who's died or had an infection or revision following a knee replacement," she continues, "so it's important to discuss these issues with patients who are considering surgery. Physicians also have to be aware of the way in which socioeconomic inequality plays out in the health care system."
-end-
About Hospital for Special Surgery

Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics, No. 3 in rheumatology and No. 7 in geriatrics by U.S. News & World Report (2015-2016), and is the first hospital in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center three consecutive times. HSS has one of the lowest infection rates in the country. HSS is a member of the New York-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical College and as such all Hospital for Special Surgery medical staff are faculty of Weill Cornell. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at http://www.hss.edu.

Hospital for Special Surgery

Related Knee Replacement Articles from Brightsurf:

Study compares racial disparities in unilateral versus bilateral knee replacement
Analyzing data from the NIS - Healthcare Cost and Utilization Project database, researchers at Hospital for Special Surgery (HSS) found that African Americans were much less likely to undergo bilateral knee replacement compared to white patients.

Steroid injections do not hasten the need for knee replacement
New research shows that corticosteroid injections for knee OA treatment do not hasten a patient's progression to a total knee replacement when compared with hyaluronic acid injections.

Warfarin use significantly increases risk of knee and hip replacement in people with OA
New research shows that use of warfarin is associated with a significantly greater risk of knee and hip replacements in patients with OA.

Younger knee replacement patients more likely to require reoperation
Knee replacement surgery, also known as total knee arthroplasty (TKA), is increasing among patients 65 and younger.

Osteoarthritis: Conservative therapy delays need for knee and hip joint replacement surgery
With implementation of conservative treatment methods like physiotherapy and individually tailored, adjusted exercises, quality of osteoarthritis care can improve and patients can delay the need for an artificial hip or knee joint.

Changes in opioid use after hip, knee replacement
Researchers looked at changes in opioid prescribing rates and level of pain control in patients who had hip or knee replacement in the U.S. from 2014 to 2017.

Knee replacement timing is all wrong for most patients
The timing of knee replacement surgery is critical to optimize its benefit.

Study: 'Pre-habilitation' by peer coaches before knee replacement may improve outcomes
HSS researchers launched a study to see if a 'pre-habilitation'' program - counseling by a peer coach who has already had knee replacement - could empower and inform patients scheduled for the surgery and lead to better outcomes.

Study finds racial variation in post-op care after knee replacement surgery
A large study analyzing 107,000 knee replacement surgeries found that African Americans were significantly more likely than white patients to be discharged to an inpatient rehabilitation or skilled nursing facility rather than home care after the procedure.

Race and poverty not risk factors for total knee replacement revision or failure
In a new study published in Arthritis Care & Research, HSS investigators found race and poverty are not risk factors for total knee replacement revision or failure at a high-volume orthopedic hospital.

Read More: Knee Replacement News and Knee Replacement Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.