Racial and Ethnic Disparities in Primary Total Knee Arthroplasty Outcomes: A Systematic Review and Meta-Analysis of Two Decades of Research

Authors

Madhu Balachandran, Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, D.C., USA.
Sarah Prabhakar, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Washington, D.C., USA.
Wei Zhang, Department of Mathematics & Statistics, University of Arkansas, Little Rock, AZ, USA.
Michael Parks, Hospital for Special Surgery, New York City, NY, USA.
Yan Ma, Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. yanma@pitt.edu.

Document Type

Journal Article

Publication Date

10-1-2025

Journal

Journal of racial and ethnic health disparities

Volume

12

Issue

5

DOI

10.1007/s40615-024-02105-x

Keywords

Disparities; Ethnicity; Race; Total Knee Arthroplasty

Abstract

Racial disparities in outcomes following total knee arthroplasty (TKA) remain persistent. This systematic review and meta-analysis aims to comprehensively synthesize data between 2000-2020. An electronic search of studies was performed on PubMed, SCOPUS, and the Cochrane Library databases from January 1, 2000, and December 31, 2020. Random effects models were used to report unadjusted and adjusted estimates for a comprehensive list of care outcomes in TKA. 63 studies met PRISMA criteria. Black patients report greater odds of in-hospital mortality (odds ratio [OR]: 1.37, 95% CI: 1.00-1.59 (p = 0.049); adjusted OR [aOR]: 1.34, 95% CI: 1.09-1.64), in-hospital complications (OR: 1.31, 95% CI: 1.27-1.35), 30-day complications (aOR: 1.19, 95% CI: 1.07-1.33), infection (OR: 1.11, 95% CI: 1.07-1.16; aOR: 1.30, 95% CI: 1.16-1.46), bleeding (OR: 1.33, 95% CI: 1.03-1.71; aOR: 1.47, 95% CI: 1.23-1.75), peripheral vascular events (PVE) (aOR: 1.46, 95% CI: 1.11-1.92), length of stay (LOS) (OR: 1.20, 95% CI: 1.08-1.34), extended-LOS (aOR: 1.89, 95% CI: 1.53-2.33), discharge disposition (OR: 1.59, 95% CI: 1.29-1.96; aOR: 1.96, 95% CI: 1.70-2.25), 30-day (OR: 1.20, 95% CI: 1.13-1.27; aOR: 1.17 95% CI: 1.09-1.26) and 90-day (OR: 1.46, 95% CI: 1.17-1.82) readmission compared to White patients. Disparities in bleeding, extended-LOS, discharge disposition, PVE, and 30-day readmission were observed in Asian patients. Hispanic patients experienced disparities in extended LOS and discharge disposition, while Native-American patients had disparities in bleeding outcomes. Persistent racial disparities in TKA outcomes highlight a need for standardized outcome measures and comprehensive data collection across multiple racial groups to ensure greater healthy equity.

APA Citation

Balachandran, Madhu; Prabhakar, Sarah; Zhang, Wei; Parks, Michael; and Ma, Yan, "Racial and Ethnic Disparities in Primary Total Knee Arthroplasty Outcomes: A Systematic Review and Meta-Analysis of Two Decades of Research" (2025). GW Authored Works. Paper 8341.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8341

Department

Epidemiology