The Public Health Impact of Lower Knee Replacement Rates among Racial Minorities


New research from Brigham and Women’s Hospital shows that lower utilization of total knee replacements among black Americans is associated with significant losses in well-being.    

Total knee replacement (TKR) surgery improves the quality of life of people with advanced knee osteoarthritis. However, research shows that racial minorities with knee osteoarthritis are less likely to be offered TKR, less likely to opt for the surgery, and experience higher rates of complications after TKR.

A new study from researchers at Brigham and Women’s Hospital (BWH) is the first to evaluate the public impact of lower TKR uses on the wellbeing of black Americans with knee osteoarthritis.

“Our study found that black Americans, as a population, lose 72,000 quality-adjusted life years (QALYs) due to racial disparities in the lower rates of TKRs offer and acceptance, and higher rates of complications,” says Elena Losina, PhD, a researcher within the Department of Orthopaedic Surgery at BWH, and senior author of the study published in Arthritis Care & Research.

According to the study, increasing offer rates and reducing complications, compared to rates seen in white counterparts, could lead to substantial gains in communal quality-adjusted life years among black Americans with advanced knee osteoarthritis.

“The lower offer rates may partially stem from physician’s assessment of their patient’s ‘fit’ for TKR and likelihood for an excellent outcome. It’s important to understand that about 80 percent of patients experience a reduction in pain and tremendous improvements in functional status,” says Dr. Losina.

Even though TKR greatly reduces pain and improves the ability of patients to resume activities of daily living, racial minorities may be less likely to accept TKR due to many factors, including:

  • Poor understanding of the surgery
  • Inadequate expectations
  • Cultural and religious preferences
  • Negative influence from members of their communities

Dr. Losina and colleagues contend that reduced acceptance rates could potentially be improved by educating patients in the following ways:

  • Thoroughly discussing the benefits of the surgery
  • Addressing patient concerns to alleviate uncertainties
  • Discussing cultural and religious preferences
  • Encouraging patients to participate in the decision-making processes

In addition, patient preferences and concerns could potentially be addressed by social workers or with peers during educational support groups.

“We hope this research raises the awareness of this racial disparity within the medical community, and helps healthcare providers understand how they might improve the wellbeing of knee osteoarthritis patients from racial and ethnic minorities,” says Dr. Losina.

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