Black patients less likely to be offered or receive knee replacement

The quality of life of black patients with knee osteoarthritis is being impacted by their underutilization of total knee replacement (TKR) surgery, according to a study published in Arthritis Care & Research, with fewer black people being offered the surgery—and when it is offered, they’re less likely than white patients to get the operation.

Led by Elena Losina, PhD, co-director of the Orthopedics and Arthritis Center for Outcomes Research at Brigham and Women's Hospital, the study estimated black patients collectively lose 72,000 quality-adjusted life years (QALYs) due to these lower rates.

"Total knee replacement is a commonly used surgery that has remarkable impact on quality of life improvement,” Losina said in a press release. “This is the first study that translates lower utilization of TKR by racial minorities into tangible losses in patients' well-being due to underuse of this highly efficacious procedure.”

By the researchers’ estimates, 12 percent of black patients with knee osteoarthritis were offered TKR surgery compared to 23 percent of white patients. Of those who were offered the surgery, 59 percent of black men and 83 percent of white man decided to undergo the procedure, as did 64 percent of black women and 78 percent of white women.

TKR has been a part of the Hospital Readmission Reduction Program since 2015 and safety-net hospitals—which have been shown to serve more minority patients—did face larger penalties under that initiative. The results of the study may be due to preferences of black patients, according to Said Ibrahim, MD, MPH, MBA, a researcher at Weill Cornell Medicine, who has not involved in the study.

“Access to insurance or lower prevalence of knee osteoarthritis among minority patients is the not the reason,” Ibrahim said to Reuters. “Similarly, it is not clear that orthopedic surgeons, who are predominantly white men, are less willing to operate on minority patients with health insurance.”