Session Type: Abstract Submissions (ACR)
Background/Purpose: The existence of racial disparities in total knee (TKR) and total hip (THR) replacement outcomes is well established but not well understood. The burden of musculoskeletal co-morbidities was investigated among black and white TKR and THR patients at the time of surgery to assess whether that explains disparities in a prospective cohort.
Methods: Descriptive analyses were performed on a cohort of 3,306 TKR and 2,439 THR patients. Data collected include sociodemographics (age, gender, race), body mass index (BMI), modified Charlson co-morbidity scores, operative joint pain severity using the Knee Injury/Hip Disability and Osteoarthritis Outcome Scores (KOOS/HOOS,), function based on the Short Form 36 (SF-36) Physical Component Score (PCS), emotional health using the SF-36 Mental Component Score (MCS), and musculoskeletal co-morbidity using the KOOS/HOOS (number of nonoperative hip and knee joints with moderate to severe pain; range 0-3) and Oswestry Disability Index (ODI). Factors associated with pre-operative pain and function were examined using multivariable stepwise linear regression models.
Results: At time of surgery, black TKR patients were significantly younger (62.0 vs. 66.9 years old), female (69.7% vs. 60.8%), heavier (34.6 vs. 31.3 BMI), exhibited higher prevalence of 2-5 medical co-morbidities (17.0% vs. 9.2%), poorer emotional health (47.4 vs. 52.1), poorer surgical knee pain (43.4 vs. 53.2), poorer function (31.3 vs. 33.1), and more pain in other weight-bearing joints than whites (p<0.02). In regression models, after adjusting for these independent variables, race did not explain the differences in surgical knee pain and function at time of surgery (-4.3-0.8 p>0.05), while moderate to severe pain in up to three lower extremity joints had a significant effect (-23.4-[-15.9], p<0.0001).
At time of surgery, black THR patients were significantly younger (59.9 vs. 64.7 years old), heavier (31.7 vs. 29.1 BMI), exhibited higher prevalence of 2-5 medical co-morbidities (14.1% vs. 6.9%), poorer emotional health (47.0 vs. 50.9), greater surgical hip pain (39.3 vs. 49.2), poorer function (30.0 vs. 31.6), and more pain in other weight-bearing joints than whites (p<0.04). In regression models, after adjusting for these independent variables, race did not explain the differences in surgical hip pain and function at time of surgery (-3.1-3.3, p>0.05), while moderate to severe pain in up to three lower extremity joints had a significant effect (-19.9-(-11.9), p<0.0001).
Conclusion: Black patients exhibit poorer function at the time of surgery compared to whites. This difference was influenced by a greater burden of musculoskeletal pain in the large weight-bering joints in the legs. Racial disparities have been well established in previous studies. In this sample, musculoskeletal co-morbid pain was found to explain much of the poorer pre-operative function seen in black patients.
L. R. Harrold,
Zimmer, Omni Sciences Inc., DePuy, J+J,
P. D. Franklin,
NIAMS-NIH, NLM-NIH, AHRQ, Zimmer, ,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/musculoskeletal-pain-explains-differences-in-function-at-time-of-surgery-in-black-tkr-and-thr-patients/