Ghoshal Soham, Liimakka Adriana P, Harary Joyce, Al-Nassir Zaid, Chen Antonia F
Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts.
Force Therapeutics, New York, New York.
J Arthroplasty. 2025 May;40(5):1131-1138. doi: 10.1016/j.arth.2024.10.116. Epub 2024 Oct 29.
Utilization of and access to total joint arthroplasty (TJA) are disproportionately skewed in patients who have low socioeconomic status (SES) and in minority populations. Patient-reported outcome measures (PROMs) are critical markers of post-surgical outcomes following TJA. This study aimed to: 1) evaluate differences in race, SES, and demographic factors between TJA patients who achieved substantial clinical benefit (SCB) and those who did not; 2) assess differences between preoperative PROMs in these patients; and 3) identify whether race and SES are associated with SCB achievement at 1-year post-TJA.
This retrospective cohort study included 1,154 total hip arthroplasty (THA) and 1,879 total knee arthroplasty (TKA) patients who underwent surgery at a single academic medical center from May 2019 to February 2023. Preoperative and postoperative PROMs were collected using the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and Hip Disability and Osteoarthritis Outcome Score for Joint Replacement surveys. Demographic and comorbidity data were collected from charts. Multivariable logistic regression analyzed the association between predictive variables and SCB achievement.
No differences in race were found between patients who achieved SCB and those who did not for both TKA and THA (P > 0.05). However, preoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores were lower in Black (P = 0.004) and Hispanic (P < 0.001) patients and preoperative Hip Disability and Osteoarthritis Outcome Score for Joint Replacement scores were lower in Black patients (P < 0.001) than White patients. A higher proportion of patients in the lowest income category achieved SCB for both THA and TKA than those in other income categories (P = 0.04, P = 0.03, respectively). However, race was not associated with SCB likelihood at one year. For TKA patients, men were negative, and bilateral simultaneous TKA was positively associated with SCB achievement when controlling for race, income, and body mass index (P < 0.001, P = 0.01, respectively).
Race and income category were not significantly associated with achieving SCB at one year among TJA patients. However, non-White patients had a similar likelihood of achieving SCB as White patients, even with lower preoperative PROMs, indicating that these patients may benefit greatly from TJA despite delays in care. Men were negatively associated with TKA SCB achievement, while bilateral simultaneous TKA was positively associated with SCB.
全关节置换术（TJA）的使用和可及性在社会经济地位（SES）较低的患者和少数族裔人群中存在不成比例的偏差。患者报告的结局指标（PROMs）是TJA术后结局的关键标志。本研究旨在：1）评估在TJA术后获得显著临床益处（SCB）的患者与未获得显著临床益处的患者在种族、SES和人口统计学因素方面的差异；2）评估这些患者术前PROMs的差异；3）确定种族和SES是否与TJA术后1年的SCB达成相关。
这项回顾性队列研究纳入了2019年5月至2023年2月在单一学术医疗中心接受手术的1154例全髋关节置换术（THA）患者和1879例全膝关节置换术（TKA）患者。使用关节置换的膝关节损伤和骨关节炎结局评分以及关节置换的髋关节残疾和骨关节炎结局评分调查收集术前和术后的PROMs。从病历中收集人口统计学和合并症数据。多变量逻辑回归分析预测变量与SCB达成之间的关联。
在TKA和THA中，获得SCB的患者与未获得SCB的患者在种族方面均未发现差异（P>0.05）。然而，黑人（P=0.004）和西班牙裔（P<0.001）患者的术前关节置换膝关节损伤和骨关节炎结局评分低于白人患者，黑人患者（P<0.001）的术前关节置换髋关节残疾和骨关节炎结局评分低于白人患者。与其他收入类别相比，最低收入类别的患者在THA和TKA中获得SCB的比例更高（分别为P=0.04，P=0.03）。然而，种族与1年时的SCB可能性无关。对于TKA患者，在控制种族、收入和体重指数时，男性与SCB达成呈负相关，双侧同期TKA与SCB达成呈正相关（分别为P<0.001，P=0.01）。
在TJA患者中，种族和收入类别与1年时获得SCB无显著关联。然而，非白人患者获得SCB的可能性与白人患者相似，即使术前PROMs较低，这表明这些患者尽管就医延迟，但可能从TJA中获益巨大。男性与TKA的SCB达成呈负相关，而双侧同期TKA与SCB达成呈正相关。
