Does race or socioeconomic status correlate with longer delays, higher pain levels for total joint surgery patients? A new study of 407 total joint patients in Chicago says it does.
The research, “The Impact of Race and Socioeconomic Status on Total Joint Arthroplasty Care,” appears online in the March 5, 2021 edition of The Journal of Arthroplasty. Undertaken by investigators at the Northwestern Medicine Feinberg School of Medicine and Midwest Orthopaedics at Rush, both in Chicago, Illinois, the study investigators collected data for 407 total joint arthroplasty (TJA) patients (131 Black and 276 white). The investigators used the Kellgren-Lawrence grading scale to determine the severity of each patient’s osteoarthritis (OA). Finally, investigator used two scales to measure joint pain: the Knee Society Score and the Harris Hip Score.
According to the researchers, the data showed that Black patients had significantly greater Kellgren-Lawrence scores than white patients. However, there were no statistically significant racial differences in the mean preoperative Kellgren-Lawrence or Harris Hip Score. In addition, the authors reported that Black patients waited, on average, 35% longer to undergo TJA surgery. Finally, the data for low income patients showed that they tended to have a higher Kellgren-Lawrence grade, a lower Knee Society Score, and a lower Harris Hip Score.
OTW asked co-author Brett Levine, M.D., M.S., associate professor at Rush University Medical Center in Chicago if he saw any reasons which would account for longer wait times. He said, “Longer wait times can include access to care issues related to insurance type, distance to travel for care and trust concerns with medical health care in general. In addition, there could be a surgical wait time due to volume, [the trend to] move to outpatient surgery for healthy patients, and insurance restrictions (due to recent cuts and declining reimbursement in general). Then there is the need to maintain work status (can’t afford to take time off), willingness to put up with higher levels of pain and dysfunction before seeking surgery, and not begin willing to risk return to work (fear that joint replacement will compromise their ability to perform heavy labor).”
“Income is often related to Kellgren-Lawrence grade in that many times those with a higher income have a less physically demanding job and a lower Kellgren-Lawrence grade. They have less concerns with return to work and are willing to put up with less dysfunction from joint pain. Those with a higher Kellgren-Lawrence grade are often laborers that fear they might not able to return to work, they cannot afford the time off and are willing to put up with more pain before surgery. Therefore in the end their Kellgren-Lawrence grades are much worse when they decide on surgery than those with higher incomes that are willing to have surgery sooner. Often those with lower Kellgren-Lawrence scores and higher incomes are looking to resume golf play or recreational activities and those with lower income and higher KL scores are looking to resume construction and heavy labor type jobs.”
