Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2018; 9(10): 220-228
Published online Oct 18, 2018. doi: 10.5312/wjo.v9.i10.220
Does ethnicity and education influence preoperative disability and expectations in patients undergoing total knee arthroplasty?
Madeline Therese Kudibal, Thomas Kallemose, Anders Troelsen, Henrik Husted, Kirill Gromov
Madeline Therese Kudibal, Anders Troelsen, Henrik Husted, Kirill Gromov, Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
Thomas Kallemose, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
Author contributions: Kudibal MT, Troelsen A, Husted H, and Gromov K contributed to study conception and design; Kudibal MT, Kallemose T, and Gromov K to data acquisition, analysis and interpretation; Kudibal MT and Gromov K contributed to writing the article; all authors contributed to editing, reviewing and final approval of article.
Supported by the Danish Rheumatism Association, No. R111-A2587.
Institutional review board statement: No approval from the National Ethics Committee was necessary as this was a non-interventional observational study. Permission to store and review patient data was obtained from the Danish Data Protection Agency Jr, No. 2007-58-0015.
Informed consent statement: Informed consent was obtained from all individual participants included in the study.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
STROBE statement: the STROBE checklist was adopted in preparation of this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Madeline Therese Kudibal, MD, Doctor, Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Kettegård alle 30, Hvidovre 2650, Denmark. madelinetherese@hotmail.com
Telephone: +45-53-669073
Received: April 28, 2018
Peer-review started: April 28, 2018
First decision: June 15, 2018
Revised: June 22, 2018
Accepted: June 27, 2018
Article in press: June 27, 2018
Published online: October 18, 2018
Abstract
AIM

To investigate whether minority ethnicity and the duration of education influence preoperative disability and expectations in patients undergoing total knee arthroplasty.

METHODS

We prospectively included 829 patients undergoing primary unilateral total knee arthroplasty (TKA) from April 2013 to December 2014 at a single centre. Patients filled in pre-operative questionnaires with information regarding place of birth, duration of education, expectations for outcome of surgery and baseline characteristics. Patients were stratified based on ethnicity. Majority ethnicity was defined as born in the study country and minority ethnicity was defined as born in any other country. Similarly, patients were stratified based on duration of education in groups defined as < 9 years, 9-12 years and > 12 years, respectively.

RESULTS

We found that 92.2% of patients were of majority ethnicity. We found that 24.5%, 44.8% and 30.8% of patients had an education of < 9 years, 9-12 years and > 12 years, respectively. The mean preoperative (pre-OP) oxford knee score (OKS) in the total population was 23.6. Patients of minority ethnicity had lower mean pre-OP OKS (18.6 vs 23.9, P < 0.001), higher pain levels (VAS 73.0 vs 58.7, P < 0.001), expected higher levels of post-OP pain (VAS 14.1 vs 6.1, P = 0.02) and of overall symptoms (VAS 16.6 vs 6.4, P = 0.006). Patients with > 12 years education had lower mean pre-OP OKS (21.5 vs 23.8 and 24.6, P < 0.001) and higher pre-OP VAS pain (65.4 vs 59.2 and 56.4, P < 0.001) compared to groups with shorter education. One year post-operative (post-OP) patients of minority ethnicity had lower mean OKS, higher pain and lower QoL. One year post-OP patients with > 12 years education reported higher pain compared to patients with shorter educations. However, the response-rate was low (44.6%), and therefore post-OP results were not considered to be significant.

CONCLUSION

Minority ethnicity and the duration of education influence preoperative disability and expectation in patients undergoing TKA. This should be taken into account when patients are advised pre-operatively.

Keywords: Socioeconomic factors, Ethnicity, Education, Expectations to surgery, Preoperative disability, Total knee arthroplasty

Core tip: We investigated whether minority ethnicity and duration of education influence preoperative disability and expectations in patients undergoing total knee arthroplasty. We prospectively included 829 patients scheduled to undergo primary total knee arthroplasty in a single centre. We found that patients of minority ethnicity suffer from more severe preoperative symptoms and expect a poorer post-operative outcome compared to patients of majority ethnicity. We also found that patients with > 12 years education have more severe preoperative symptoms compared to patients with shorter educations. This information can assist surgeons in appropriate treatment plans and preoperative consultation for all patients.