Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Blacks in the United States (US) are less likely to undergo total knee arthroplasty (TKA) than whites, in part because they expect to benefit less. Whether their lower expectations are justified is unclear. The objective of this systematic literature review was to compare Health Related Quality of Life (HRQOL), pain, function, and satisfaction after TKA in US blacks andUS whites.
Methods: A librarian assisted search was performed on 12/14/2014 using PUBMED, EMBASE and the Cochrane Central Register. In addition, a hand search of journals focusing on disparities was performed. The following key terms were used: total knee replacement, quality of life, outcomes, and satisfaction. The search was limited to studies published during or after the year 2000. The population of interest was black US adults, the intervention was TKA, and the comparator was white US adults. Outcomes were HRQOL, pain, function and satisfaction following TKA. High quality observational cohorts with ≥ 6 month follow-up after TKA were included.
Results: 4781 studies were identified and screened by title, 346 by abstract, and 18 by full text. Only 7 studies met inclusion criteria and included race in the analysis. These studies represented a total of 4559 TKA patients of whom 482 (11%) were black. Because the studies used different outcome measures and were inconsistent in their adjustment for confounders, we could not perform a quantitative synthesis of the results. In 4 studies US blacks had worse pain, in 4 worse function, and in 1 less satisfaction 6 months-2 years after TKR.
Conclusion: US blacks may derive less benefit from TKA than whites as measured by HRQOL, pain, function and satisfaction, and this may contribute to lower rates of TKA utilization by blacks. Many large studies assessing predictors of patient related TKA outcomes fail to analyze race as a variable, which limited our study. More studies assessing the impact of race and socioeconomic factors on TKA outcomes are needed.
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Table 1. Included Studies |
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Citation |
Years |
Duration follow up |
Outcomes analyzed |
Total |
White |
Black |
Significantly worse in black patients |
Adjusted |
Notes |
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|
Age |
Sex |
LOS |
Comorbidity |
SES |
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|
Maratt Jo Aa 2015 |
2001-2007 |
2 yrs |
WOMAC Pain Stiffness Function |
2322 |
2108 |
101 |
WOMAC pain |
Ö |
Ö |
Ö |
Ö |
Ö |
Large number of excluded patients may have biased results |
|
Barrack CORRb 2014 |
NA |
1-4 yrs |
Function Residual symptoms Return to work UWSC satisfatction* |
661 |
573 |
85 |
Pain Function** |
Ö |
Ö |
Retrospective |
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|
Jacobs JoAa 2014 |
NA |
2-5 yrs |
Satisfaction† |
989 |
830 |
49 |
Satisfaction |
Ö |
Ö |
no |
SES not analyzed |
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|
KamathCORRb 2010 |
2004 |
2-5 yrs |
ROM KSS |
185 |
87 |
90 |
KSS ROM |
Ö |
no |
Retrospective |
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|
Lavernia CORRb 2011 |
1992-2007 |
2-16 yrs |
ROM Radiographs QWB SF-36 WOMAC HSS KSKS HHS score MAP Score |
1010 |
176 |
74 |
QWB SF-36 physical WOMAC pain WOMAC function |
Ö |
no |
Single surgeon study |
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|
Lopez-Olivo ARDc 2011 |
2004-2005 |
6mo |
WOMAC pain, function KSRS total KRS function |
241 |
166 |
61 |
KSRS function |
Ö |
Ö |
May not be generalizable |
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Styron JBJSd 2011 |
1,3,6 mo |
KOOS, WOMAC SF-12 Time to return to work |
162 |
137 |
22 |
KOOS ADL Pain KOOS QOL WOMAC pain WOMAC ADL |
Ö |
Ö |
More blacks lost to follow up |
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*Survey designed by The University of Wisconsin Survey Center (UWSC); targeted satisfaction with overall knee function, ability to perform daily activities, and pain relief, using a 5 point Likert scale **Questions worse in minority patients included: problems getting in and out of the car or chair, difficulty going up and down stairs, experienced pain in the last 30 days, limp while walking †Patients were asked if they were satisfied with their surgery and given the options “yes” “no” or “I’m not sure” -“yes” were categorized as satisfied KSS=Knee Society Score; WOMAC=Western Ontario and McMaster Universities Osteoarthritis Index, QWB= quality of well-being score, HSS=Hospital for Special Surgery; KSKS=Knee Society Knee Score; MAP score = Merle d’Aubigne´-Postel score aJoA Journal of Arthroplasty; bCORR Clinical Orthropedic and Related Research; cARD Annals of Rheumatic Disease; dJBJS Journal of Bone and Joint Surgery |
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To cite this abstract in AMA style:
Goodman SM, McHugh K, Parks M, Figgie MP, Lee YY, Fields K, Smethurst R, Bass AR. Racial Disparities in Pain and Function after Total Knee Arthroplasty in the United States: A Systematic Literature Review [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/racial-disparities-in-pain-and-function-after-total-knee-arthroplasty-in-the-united-states-a-systematic-literature-review/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/racial-disparities-in-pain-and-function-after-total-knee-arthroplasty-in-the-united-states-a-systematic-literature-review/