title: Ethnic and gender differences in the functional disparities after primary total knee arthroplasty.
abstract: BACKGROUND
  The benefits of TKA have been well documented. Whether these benefits apply equally across gender and ethnic groups is unclear. Given the underuse of TKA among certain demographic groups, it is important to understand whether gender or ethnicity influence pain and function after TKA.
  
  
  OBJECTIVE
  We determined (1) the influence of race, gender, and body mass index (BMI) on primary TKA functional scores and ROM before gender-specific implants; and (2) whether comorbidities influenced ROM and functional scores.
  
  
  METHODS
  We reviewed all 202 patients who underwent primary TKAs in 2004. We contacted 185 of the 202 patients, including 90 African-Americans, 87 Caucasians, four Asians, and four Hispanics (55 men, 130 women). Their average age was 66 years, and average BMI was 34.4 (range, 20-55). Knee Society scores (KSS) and ROM, patient demographics, and the Charlson Comorbidity Index (CCI) were recorded. Minimum followup was 24 months (average, 29.1 months; range, 24-60.3 months).
  
  
  RESULTS
  African-Americans had longer delays to presentation, higher BMI, and worse 2-year KSS. Women (all races) had higher BMI and worse preoperative flexion/arc ROM. African-American women had worse final ROM and had similar final gains in ROM (postoperative minus preoperative ROM) after controlling for confounders.
  
  
  CONCLUSIONS
  Gender and race affected functional KSS and ROM variables. The worse results experienced by African-American women may be attributable to a longer delay to presentation. However, the scores and motion were high for all subgroups, and underuse of TKA in women and African-Americans cannot be justified based on a perception of lesser functional gains.
authors.affiliation: Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Atul F
authors.initials: AF
authors.lastname: Kamath
authors.forename: John G
authors.initials: JG
authors.lastname: Horneff
authors.forename: Vandy
authors.initials: V
authors.lastname: Gaffney
authors.forename: Craig L
authors.initials: CL
authors.lastname: Israelite
authors.forename: Charles L
authors.initials: CL
authors.lastname: Nelson
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001213:Asian; D015992:Body Mass Index; D015897:Comorbidity; D005006:Ethnicity; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000208:ethnology / Q000209:etiology*; D010414:Pennsylvania; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D044465:White People; D014942:Workers' Compensation