Prospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2020; 11(5): 265-277
Published online May 18, 2020. doi: 10.5312/wjo.v11.i5.265
Impact of gender and race on expectations and outcomes in total knee arthroplasty
Brian A Perez, James Slover, Emmanuel Edusei, Annamarie Horan, Afshin Anoushiravani, Atul F Kamath, Charles L Nelson
Brian A Perez, Annamarie Horan, Charles L Nelson, Department of Orthopedics, University of Pennsylvania, Philadelphia, PA 19104, United States
James Slover, Emmanuel Edusei, Afshin Anoushiravani, Department of Orthopedic Surgery, New York University Langone Health, New York, NY 10016, United States
Atul F Kamath, Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH 44195, United States
Author contributions: Nelson CL and Slover J designed the research; Perez BA, Edusei E, Anoushiravani A performed the research; Horan A contributed the analysis of the data, Perez BA wrote the paper; Nelson CL, Slover J, Edusei E, Anoushiravani A, and Kamath AF provided edits to the paper.
Institutional review board statement: The study was reviewed and approved by the NYU School of Medicine’s Institutional Review Board and the University of Pennsylvania’s Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data is available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Brian Perez, MD, Doctor, Orthopaedic Resident, Department of Orthopaedics, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States. brian.perez@pennmedicine.upenn.edu.
Received: January 1, 2020
Peer-review started: January 1, 2020
First decision: February 19, 2020
Revised: April 1, 2020
Accepted: April 8, 2020
Article in press: April 8, 2020
Published online: May 18, 2020
Processing time: 138 Days and 9.1 Hours
Abstract
BACKGROUND

Total joint arthroplasty is one of the most common surgeries performed in the United States with total knee arthroplasty (TKA) being one of the most successful surgeries for restoring function and diminishing pain. Even with the demonstrated success of TKA and a higher prevalence of arthritis and arthritis related disability among minorities, racial and gender disparity remains a constant issue in providing care for the adult reconstruction patient.

AIM

To assess the role of demographics and expectations on differences in perioperative patient reported outcomes (PRO) following TKA.

METHODS

One hundred and thirty-three patients scheduled for primary unilateral TKA secondary to moderate to severe osteoarthritis were enrolled in this two-institution prospective study. Validated PRO questionnaires were collected at four time points. Statistical analysis was conducted to determine the impact of gender, ethnic background and expectation surveys responses to assess PRO at these time points.

RESULTS

Females were associated with worse preoperative Knee Injury and Osteoarthritis Outcome Scores (KOOS) for symptoms, pain, and activities of daily living. African Americans were associated with worse KOOS for pain, activities of daily living, and quality of life. Despite worse preoperative scores, no difference was noted in these categories between the groups postoperatively. Additionally, all pre-operative psychometric scales were equivalent across groups except Geriatric Depression scale, which was significantly different between groups within the Race and Age Group (P < 0.05). Conversely, Pain Catastrophizing Scale, was significantly different for all subscales and total score within Age Group (P < 0.05), and the Magnification, Helplessness subscales as well as the Total score were significantly different between groups for Race and Relationship Status (P < 0.01).

CONCLUSION

We conclude that female and African American patients have lower preoperative KOOS scores compared to white male patients. No postoperative differences in outcomes between these groups.

Keywords: Knee; Joints; Arthroplasty; Osteoarthritis; Race; Gender; Postoperative; Outcomes

Core tip: Total knee arthroplasties (TKA) are one of the most common surgeries performed in the United States. Even with its popularity, it has been shown that African Americans and women are offered this surgery less than their white male counterparts. We explore the role of potential factors connected to the underutilization of TKA in minorities and women as well as assess patient expectations and outcomes associated with race and gender. We conclude that there are no differences in outcomes between race and gender which leads us to believe that TKA should be offered to everyone equally to remedy disparities.