title: Does Race Affect Outcomes in Total Joint Arthroplasty?
abstract: BACKGROUND
  Several studies suggest worse surgical outcomes among racial/ethnic minorities. There is a paucity of research on preoperative and postoperative pain, general health, and disease-specific measures in which race is the main subject of investigation; furthermore, the results are not conclusive.
  
  
  OBJECTIVE
  (1) Do black patients have more severe or more frequent preoperative pain, well-being, general health, and disease-specific scores when compared with white patients? (2) Are there differences between black patients and white patients after hip or knee arthroplasty on those same measures?
  
  
  METHODS
  In this retrospective study, we used an institutional arthroplasty registry to analyze data on 2010 primary arthroplasties (1446 knees and 564 hips) performed by one surgeon at a single institution. Cases from patients self-identifying as black (n = 105) and white (n = 1905) were compared (controlling for confounders, including age and ethnicity) on the following preoperative and postoperative patient-oriented outcomes: pain intensity/frequency as measured by a visual analog scale (VAS), Quality of Well-Being (QWB-7), SF-36, and WOMAC scores. T-tests, chi square, and multivariate analysis of covariance were used. Alpha was set at 0.05. Postoperative analysis was performed only on those cases that had a minimum followup of 1 year (mean, 3.5 years; range, 1-9 years). Of the 2010 arthroplasties, 37% (39 of 105) of those cases performed in black patients and 64% (1219 of 1905) of those performed in white patients were included in the final postoperative model (multivariate analysis of covariance).
  
  
  RESULTS
  Black patients had more severe preoperative pain intensity (VAS: 8 ± 1.8 versus 8 ± 2.0, mean difference = 0.76 [95% confidence interval {CI}, 0.34-1.1], p < 0.001). Black patients also had worse well-being scores (QWB-7: 0.527 ± 0.04 versus 0.532 ± 0.05, mean difference = -0.01 [CI, -0.02 to 0.00], p = 0.037). Postoperatively, pain intensity (VAS: 1 ± 3.1 versus 1 ± 1.8, mean difference= 0.8 [CI, 0.19-1.4], p= 0.010) and (QWB-7: 0.579 ± 0.09 versus 0.607 ± 0.11, mean difference= -0.049 [CI, -0.08 to -0.01], p = 0.008) were different but without clinical significance.
  
  
  CONCLUSIONS
  Black patients underwent surgery earlier in life and with different preoperative diagnoses when compared with white patients. Black patients had worse preoperative baseline pain, well-being, general health, and disease-specific scores as well as worse postoperative scores. However, these differences were very narrow and without clinical significance. Notwithstanding, the relations of race with outcomes remain complex. Further investigations to recognize disparities and minimize or address them are warranted.
  
  
  METHODS
  Level III, prognostic study.
authors.affiliation: The Center for Advanced Orthopedics at Larkin Hospital, 7000 SW 62 Avenue, Suite 600, South Miami, FL, 33143, USA. c@drlavernia.com.
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Lavernia
authors.affiliation: Arthritis Surgery Research Foundation, 7000 SW 62 Avenue, Suite 601, South Miami, FL, 33143, USA.|The Center for Advanced Orthopedics at Larkin Hospital, 7000 SW 62 Avenue, Suite 600, South Miami, FL, 33143, USA.
authors.forename: Jesus M
authors.initials: JM
authors.lastname: Villa
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000523:psychology; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000523:psychology; D016009:Chi-Square Distribution; D005260:Female; D005431:Florida / Q000453:epidemiology; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D044465:White People / Q000523:psychology; D055815:Young Adult