title: Higher Total Knee Arthroplasty Revision Rates Among United States Blacks Than Whites: A Systematic Literature Review and Meta-Analysis.
abstract: BACKGROUND
  Reportedly 2% to 5.7% of total knee arthroplasties (TKAs) require revision within 5 years. The purpose of this study was to determine whether blacks are at higher risk of TKA revision than whites in the United States.
  
  
  METHODS
  We performed a systematic review of English-language articles published from 2000 to 2015. Study inclusion criteria were (1) performance of the study in the United States, (2) TKA as the primary procedure studied, (3) a follow-up period at least 2 years, (4) reporting of revision rates, and (5) analysis of patient race as an independent predictor of revision. We then performed a random-effects meta-analysis to calculate a pooled hazard ratio for TKA revision in blacks compared with whites.
  
  
  RESULTS
  A total of 4,286 studies were identified and screened by title; 106, by abstract; and 24, by full text. Six studies met the inclusion criteria. Only 4 of the 6 studies could undergo meta-analysis because of overlapping study populations in 3 of them. The meta-analysis represented 451,960 patients who underwent TKA, of whom 28,772 (6.4%) were black. Of the total, 31,568 patients (7.0%) underwent revision surgery. The risk of revision TKA was significantly higher among blacks than whites (pooled hazard ratio, 1.38; 95% confidence interval, 1.20 to 1.58; p < 0.001). Analysis of the 3 studies with overlapping study populations demonstrated discordant results as a result of adjustment compared with non-adjustment for insurance eligibility, a surrogate for socioeconomic status.
  
  
  CONCLUSIONS
  Blacks in the United States are at higher risk of revision TKA than whites. Socioeconomic status contributed to revision risk and is an important confounder in analyses of race.
  
  
  METHODS
  Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: 1Rheumatology (A.R.B. and S.M.G.), Research (K.M.), Healthcare Research Institute (K.F.), Education (R.G.), and Orthopedics (M.L.P.), Hospital for Special Surgery, New York, NY.
authors.forename: Anne R
authors.initials: AR
authors.lastname: Bass
authors.forename: Kelly
authors.initials: K
authors.lastname: McHugh
authors.forename: Kara
authors.initials: K
authors.lastname: Fields
authors.forename: Rie
authors.initials: R
authors.lastname: Goto
authors.forename: Michael L
authors.initials: ML
authors.lastname: Parks
authors.forename: Susan M
authors.initials: SM
authors.lastname: Goodman
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D007720:Knee Prosthesis; D011183:Postoperative Complications / Q000601:surgery; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data; D014481:United States; D044465:White People / Q000706:statistics & numerical data*