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. 2021 Apr;36(4):1310-1317.
doi: 10.1016/j.arth.2020.10.057. Epub 2020 Nov 2.

Bilateral vs Unilateral Total Knee Arthroplasty: Racial Variation in Utilization and In-Hospital Major Complication Rates

Bella Mehta  1 , Kaylee Ho  2 , Jennifer Bido  3 , Stavros G Memtsoudis  4 , Michael L Parks  3 , Linda Russell  1 , Susan M Goodman  1 , Said Ibrahim  2
Affiliations

Bilateral vs Unilateral Total Knee Arthroplasty: Racial Variation in Utilization and In-Hospital Major Complication Rates

Bella Mehta et al. J Arthroplasty. 2021 Apr.

Abstract

Background: We sought to examine bilateral total knee arthroplasty (BTKA) vs unilateral TKA (UTKA) utilization and in-hospital complications comparing African Americans (AAs) and Whites.

Methods: In this retrospective analysis of patients ≥50 years who underwent elective primary TKA, the (2007-2016) database of the Healthcare Cost and Utilization Project (National Inpatient Sample) was used. We computed differences in temporal trends in utilization and major in-hospital complication rates of BTKA vs UTKA comparing AAs and Whites. We performed multivariable logistic regression models to assess racial differences in trends adjusting for individual-, hospital- and community-level variables. Discharge weights were used to enable nationwide estimates. We used multiple imputation procedures to impute values for 12% missing race information.

Results: An estimated 276,194 BTKA and 5,528,429 UTKA were performed in the US. The proportion of BTKA among all TKAs declined, and AAs were significantly less likely to undergo BTKA compared to Whites throughout the study period (trend P = .01). In-hospital complication rates for UTKA were higher in AAs compared to Whites throughout the study period (trend P < .0001). However, for BTKA, the in-hospital complication rates varied between Whites and AAs throughout the study period (trend P = .09).

Conclusion: In this nationwide sample of patients who underwent total knee arthroplasty from 2007 to 2016, the utilization of BTKA was higher in Whites compared to AAs. On the other hand, while AAs have consistently higher in-hospital complication rates in UTKA over the time period, this pattern was not consistent for BTKA.

Keywords: African American; bilateral total knee arthroplasty; in-hospital complications; knee osteoarthritis; racial disparities; unilateral total knee arthroplasty; utilization.

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Figures

Figure 1 (a)
Figure 1 (a)
Proportional Utilization of Bilateral Total Knee Arthroplasty (TKA) amongst all TKAs over time.
Figure 1 (b)
Figure 1 (b)
Utilization rate of Bilateral Total Knee Arthroplasty (TKA) per 100,000 population by race. Population estimates obtained from the Intercensal Race-Specific Estimates of Resident Population by Sex and Age for the United States: April 1, 2000 to July 1, 2010; Annual Estimates of the Resident Population by Sex, Age, Race, and Hispanic Origin for the United States: April 1, 2010 to July 1, 2019. Source: the U.S. Census Bureau, Population Division.
Figure 1 (c)
Figure 1 (c)
Bilateral total knee arthroplasty in-hospital complications in Whites and African Americans.
Figure 1 (d)
Figure 1 (d)
Unilateral total knee arthroplasty in-hospital complications in Whites and African Americans.
See this image and copyright information in PMC

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