Minority Race and Ethnicity is Associated With Higher Complication Rates After Revision Surgery for Failed Total Hip and Knee Joint Arthroplasty

Klemt, Christian; Walker, Paul; Padmanabha, Anand; Tirumala, Venkatsaiakhil; Xiong, Liang; Kwon, Young‐Min

doi:10.1016/j.arth.2020.10.043

Cited by 37 publications

(15 citation statements)

References 30 publications

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“…Johnson et al reported that Blacks undergoing THA were more likely to experience death or a serious complication (13.12% [1,273], p < 0.001) when compared with non-Hispanic Whites (10.79% [10,961], p < 0.001) 51 . Klemt et al reported that, compared with White patients, Black patients had significantly higher body mass index (BMI) (p = 0.04), American Society of Anesthesiologists score (p = 0.04), LOS (p = 0.06), and postoperative infection rates (p = 0.04), while Hispanics demonstrated significantly higher BMI (p = 0.04) and a higher risk of postoperative infection (p < 0.01) 52 .…”

Section: Resultsmentioning

confidence: 99%

“…Black patients are more likely to have a higher number of comorbidities preoperatively and increased risk of major complications, readmissions, revisions, and discharge to institutional care (SNF or IRF) after TJA compared with White patients 44-88 . Hispanic patients are also more likely to have higher numbers of comorbidities preoperatively and an increased risk of complications and readmissions after TJA 44-88 . Some of these disparities in outcomes may be explained by unequal access and disparate preoperative functional status.…”

Section: Discussionmentioning

confidence: 99%

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Race, Utilization, and Outcomes in Total Hip and Knee Arthroplasty

et al. 2022

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Background: Previous studies have shown that utilization and outcomes of total joint arthroplasty (TJA) are not equivalent across different patient cohorts. This systematic review was designed to evaluate the currently available evidence regarding the effect that patient race has, if any, on utilization and outcomes of lower-extremity arthroplasty in the United States.Methods: A literature search of the MEDLINE database was performed using keywords such as "disparities," "arthroplasty," "race," "joint replacement," "hip," "knee," "inequities," "inequalities," "health," and "outcomes" in all possible combinations. All English-language studies with a level of evidence of I through IV published over the last 20 years were considered for inclusion. Quantitative and qualitative analyses were performed on the collected data.Results: A total of 82 articles were included. There was a significantly lower utilization rate of lower-extremity TJA among Black, Hispanic, and Asian patients compared with White patients (p , 0.05). Black and Hispanic patients had lower expectations regarding postoperative outcomes and their ability to participate in various activities after surgery, and they were less likely than White patients to be familiar with the arthroplasty procedure prior to presentation to the orthopaedic surgeon (p , 0.05). Black patients had increased risks of major complications, readmissions, revisions, and discharge to institutional care after TJA compared with White patients (p , 0.05). Hispanic patients had increased risks of complications (p , 0.05) and readmissions (p , 0.0001) after TJA compared with White patients. Black and Hispanic patients reached arthroplasty with poorer preoperative functional status, and all minority patients were more likely to undergo TJA at lowquality, low-volume hospitals compared with White patients (p , 0.05).Conclusions: This systematic review shows that lower-extremity arthroplasty utilization differs by racial/ethnic group, and that some of these differences may be partly explained by patient expectations, preferences, and cultural differences. This study also shows that outcomes after lower-extremity arthroplasty differ vastly by racial/ethnic group, and that some of these differences may be driven by differences in preoperative functional status and unequal access to care.Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. E lective total hip and knee arthroplasty (THA and TKA) are 2 of the most successful procedures for treating end-stage osteoarthritis (OA) 1,2 . However, the utilization of total joint arthroplasty (TJA) is not equivalent across different demographic subsets of patients in the United Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A816).

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Race, Utilization, and Outcomes in Total Hip and Knee Arthroplasty

et al. 2022

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“…Finally, given prior research showing non-White patients tend to present for arthroplasty later in disease progression, with more severe arthritis, we were surprised that in our study population Black patients were younger (62.3 vs 68.6) and had lower medical comorbidity (CCI of 2.45 vs 2.92) compared to White non-Hispanic patients. In administrative database and retrospective institutional studies, non-White patients have been found to have higher rates of baseline comorbidity at the time of primary and revision arthroplasty [ 9 , 45 , 48 , 49 ]. It is unclear why comorbidity levels were lower in non-White patients in our study, although this likely reflects a difference in the underlying population captured by the AJRR.…”

Section: Discussionmentioning

confidence: 99%

Lower Rates of Ceramic Femoral Head Use in Non-White Patients in the United States, a National Registry Study

Upfill‐Brown

Paisner

Donnelly

et al. 2022

The Journal of Arthroplasty

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“…However, the use of electronic medical records has seen a widespread use for clinical outcome research for patients with total hip and knee arthroplasty. 6,44,45 Finally, our study findings are limited to risk factors for early THA failure within 2 years after index THA. Therefore, it remains unclear whether the same or other risk factors are associated with long-term THA failure.…”

Section: Figurementioning

confidence: 91%

The Utility of Machine Learning Algorithms for the Prediction of Early Revision Surgery After Primary Total Hip Arthroplasty

Klemt

Laurencin

Alpaugh

et al. 2022

J Am Acad Orthop Surg

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Background: Revision total hip arthroplasty (THA) is associated with increased morbidity, mortality, and healthcare costs due to a technically more demanding surgical procedure when compared with primary THA. Therefore, a better understanding of risk factors for early revision THA is essential to develop strategies for mitigating the risk of patients undergoing early revision. This study aimed to develop and validate novel machine learning (ML) models for the prediction of early revision after primary THA. Methods: A total of 7,397 consecutive patients who underwent primary THA were evaluated, including 566 patients (6.6%) with confirmed early revision THA (,2 years from index THA). Electronic patient records were manually reviewed to identify patient demographics, implant characteristics, and surgical variables that may be associated with early revision THA. Six ML algorithms were developed to predict early revision THA, and these models were assessed by discrimination, calibration, and decision curve analysis. Results: The strongest predictors for early revision after primary THA were Charlson Comorbidity Index, body mass index .35 kg/m 2 , and depression. The six ML models all achieved excellent performance across discrimination (area under the curve .0.80), calibration, and decision curve analysis. Conclusion: This study developed ML models for the prediction of early revision surgery for patients after primary THA. The study findings show excellent performance on discrimination, calibration, and decision curve analysis for all six candidate models, highlighting the potential of these models to assist in clinical practice patient-specific preoperative quantification of increased risk of early revision THA.T otal hip arthroplasty (THA) represents one of the most commonly performed procedures to treat patients with end-stage osteoarthritis to alleviate pain and restore joint functionality. 1 Recent literature demonstrated a significantly increasing demand for primary THA over the

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Minority Race and Ethnicity is Associated With Higher Complication Rates After Revision Surgery for Failed Total Hip and Knee Joint Arthroplasty

Cited by 37 publications

References 30 publications

Race, Utilization, and Outcomes in Total Hip and Knee Arthroplasty

Race, Utilization, and Outcomes in Total Hip and Knee Arthroplasty

Lower Rates of Ceramic Femoral Head Use in Non-White Patients in the United States, a National Registry Study

The Utility of Machine Learning Algorithms for the Prediction of Early Revision Surgery After Primary Total Hip Arthroplasty

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