Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Pacific Northwest University School of Health Sciences, Yakima, WA.
J Arthroplasty. 2022 Aug;37(8S):S919-S924.e2. doi: 10.1016/j.arth.2022.03.050. Epub 2022 Mar 17.
The purpose of our study was to investigate the association of race and ethnicity with the use of the newest technology and postoperative outcomes in total hip arthroplasty (THA) using the American Academy of Orthopaedic Surgeons (AAOS) American Joint Replacement Registry (AJRR).
Adult THA procedures were queried from the AJRR from 2012 to 2020. A mixed-effects multivariate regression model was used to evaluate the association of race and ethnicity with the use of the newest technology (ceramic femoral head, dual-mobility implant, and robotic assist) at 30-day, and 90-day readmission. A proportional subdistribution hazard model was used to model a risk of revision THA.
There were 85,188 THAs with complete data for an analysis of outcomes and 103,218 for an analysis of ceramic head usage. The median length of follow-up was 37.9 months (interquartile range [IQR] 21.6 to 56.3 months). In multivariate models, compared to White non-Hispanic patients, Black (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.69-0.92, P < .001), Hispanic (OR 0.76, CI 0.59-0.99, P = .037), Asian (OR 0.74, CI 0.55-1.00, P = .045), and Native American (OR 0.52, CI 0.30-0.87, P = .004) patients all had significantly lower rates of ceramic head use in THA. Compared to White non-Hispanic patients, Asian (hazard ratio [HR] 0.39, CI 0.18-0.86, P = .008) and Hispanic (HR 0.43, CI 0.19-0.98, P = .043) patients had significantly lower rates of revision. No differences in 30-day or 90-day readmission rates were seen.
Black, Hispanic, Native American, and Asian patients had lower rates of ceramic head use in THA when compared to White patients. These differences did not translate into worse clinical outcomes on a short-term follow-up. In fact, Asian patients had lower revision rates compared to non-Hispanic White patients. Additional study is necessary to evaluate the long-term consequence of lower ceramic head use in non-White patients in the United States.
本研究旨在通过美国矫形外科医师学会（AAOS）美国关节置换登记处（AJRR）调查种族和民族与全髋关节置换术（THA）中最新技术的使用和术后结果之间的关联。
从 AJRR 中查询 2012 年至 2020 年的成人 THA 手术。使用混合效应多变量回归模型评估种族和民族与 30 天和 90 天再入院时使用最新技术（陶瓷股骨头、双动植入物和机器人辅助）的相关性。使用比例亚分布危害模型对 THA 修订风险进行建模。
共有 85188 例 THA 有完整的数据进行结果分析，103218 例有陶瓷头使用分析。中位随访时间为 37.9 个月（四分位距 [IQR] 21.6 至 56.3 个月）。在多变量模型中，与白人非西班牙裔患者相比，黑人（比值比 [OR] 0.79，95%置信区间 [CI] 0.69-0.92，P<.001）、西班牙裔（OR 0.76，CI 0.59-0.99，P=.037）、亚裔（OR 0.74，CI 0.55-1.00，P=.045）和美洲原住民（OR 0.52，CI 0.30-0.87，P=.004）患者在 THA 中使用陶瓷头的比率均显著降低。与白人非西班牙裔患者相比，亚裔（危险比 [HR] 0.39，CI 0.18-0.86，P=.008）和西班牙裔（HR 0.43，CI 0.19-0.98，P=.043）患者的翻修率显著降低。在 30 天和 90 天的再入院率方面没有差异。
与白人患者相比，黑人、西班牙裔、美洲原住民和亚裔患者在 THA 中使用陶瓷头的比率较低。这些差异在短期随访中并没有转化为更差的临床结果。事实上，亚裔患者的翻修率低于非西班牙裔白人患者。需要进一步研究来评估在美国非白人患者中使用较低陶瓷头的长期后果。
