title: Complications for racial and ethnic minority groups after total hip and knee replacement: a review of the literature.
abstract: BACKGROUND
  Total hip and knee replacement reduces disability associated with lower extremity osteoarthritis. It has been shown that racial and ethnic minority groups underutilize these procedures; however, little information exists on postoperative outcomes for ethnic minorities.
  
  
  METHODS
  We conducted a systematic review of the literature to compile population-based or multicenter studies on early postoperative outcomes after total hip and knee replacement in racial and ethnic minorities.
  
  
  RESULTS
  Nine studies met the inclusion criteria. Among the nine eligible studies, four examined total knee replacement, three examined total hip replacement, and two examined both. Two studies investigated mortality after total knee replacement, and one found that blacks had an increased risk of mortality. Three studies investigated infection after total knee replacement; all found an increased risk in blacks and Hispanics. Four studies examined non-infection-related complications after total knee replacement, and all four found that nonwhites had an increased risk of complications. Two studies investigated mortality after total hip replacement; one of these found that, for primary hip replacement, blacks had an increased risk of mortality.
  
  
  CONCLUSIONS
  There is a paucity of research on outcomes after orthopaedic procedures for racial and ethnic minority groups. On the basis of the available literature, racial and ethnic minority groups appear to have a higher risk for early complications (those occurring within ninety days), particularly joint infection, after total knee replacement and perhaps a higher risk of mortality after total hip replacement.
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. Benedict_Nwachukwu@hms.harvard.edu
authors.forename: Benedict U
authors.initials: BU
authors.lastname: Nwachukwu
authors.forename: Adrian D
authors.initials: AD
authors.lastname: Kenny
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.forename: Lori B
authors.initials: LB
authors.lastname: Chibnik
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005006:Ethnicity / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008913:Minority Groups / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D016459:Prosthesis-Related Infections / Q000208:ethnology; D012923:Social Class