Authors: Soham Ghoshal ab, Adriana P. Liimakka MBI ab, Joyce Harary c, Zaid Al-Nassir c, BWH PROMs Workgroupabde, Antonia F. Chen MD, MBA a b
BWH PROMs Workgroup: Richard Iorio MD, Jeffrey K. Lange MD, Peter Meyers BS, Adam S. Olsen MD, Andrea L. Pusic MD, Vivek M. Shah MD
aHarvard Medical School, Boston, Massachusetts
bBrigham and Women’s Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts
cForce Therapeutics, New York, New York
dMass General Brigham, Department of Patient Reported Outcome Measures, Somerville, Massachusetts
eBrigham and Women’s Hospital, Department of Plastic and Reconstructive Surgery, Boston, Massachusetts
Abstract
Background
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.
Methods
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.
Results
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).
Conclusions
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.