This study explored differences in postacute disposition for total hip arthroplasty (THA) and total knee arthroplasty (TKA) with a focus on whether Asian Americans (AS) experience joint replacement disparities observed in other racial/ethnic minorities compared with majority white patients. We used data from the Nationwide Inpatient Sample for 2009 through 2012. We looked at disposition to home health care (HHC) and transfer to another facility for postacute care (e.g., skilled nursing facility, rehabilitation facility) for each of the 4 years under study. Findings for AS were mixed. There were differences in discharge to postacute facilities other than HHC for AS compared with whites for THA for 2011 and 2012. For TKA, there were differences in disposition to HHC for Asians compared with whites for 2009 and 2012; for disposition to postacute facilities other than HHC for TKA, there were differences for 2011 and 2012 only. Differences for AS in postacute disposition to facilities other than HHC appear to increase over the 4 years of the study. Further research with additional data is warranted.
BarbourKE. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation—United States, 2010–2012. MMWR Morb Mortal Wkly Rep. 2013;62(44):869-873.
2.
Centers for Disease Control and Prevention. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation–United States, 2010-2012. MMWR Morb Mortal Wkly Rep. 2013;62(44):869-873.
3.
MaurerAJonesLC. Musculoskeletal healthcare disparities: influence of patient sex, race, and ethnicity on utilization of total joint arthroplasty. J Long Term Eff Med Implants. 2014;24(2-3):233-240.
4.
KrollTLRichardsonMSharfBFSuarez-AlmazorME. “Keep on truckin’” or “It’s got you in this little vacuum”: race-based perceptions in decision-making for total knee arthroplasty. J Rheumatol. 2007;34(5):1069-1075.
5.
HanchateADZhangYFelsonDTAshAS. Exploring the determinants of racial and ethnic disparities in total knee arthroplasty: health insurance, income, and assets. Med Care. 2008;46(5):481-488.
6.
ChenJRizzoJAParasuramanSGunnarssonC. Racial disparities in receiving total hip/knee replacement surgery: the effect of hospital admission sources. J Health Care Poor Underserved. 2013;24(1):135-151.
7.
IrgitKNelsonCL. Defining racial and ethnic disparities in THA and TKA. Clin Orthop Relat Res. 2011;469(7):1817-1823.
8.
JainNBHigginsLDOzumbaD, et al. Trends in epidemiology of knee arthroplasty in the United States, 1990-2000. Arthritis Rheum. 2005;52(12):3928-3933.
9.
KuligKBinghamCOIIISteeleLL. Racial, ethnic, and geographic disparities in rates of knee arthroplasty. N Engl J Med. 2004;350(3):305-306; author reply 305-306.
10.
NelsonCL. Disparities in orthopaedic surgical intervention. J Am Acad Orthop Surg. 2007;15(Suppl 1):S13-S17.
11.
SkinnerJWeinsteinJNSporerSMWennbergJE. Racial, ethnic, and geographic disparities in rates of knee arthroplasty among Medicare patients. N Engl J Med. 2003;349(14):1350-1359.
12.
SloverJDWalshMGZuckermanJD. Sex and race characteristics in patients undergoing hip and knee arthroplasty in an urban setting. J Arthroplasty. 2010;25(4):576-580.
13.
Suarez-AlmazorMESouchekJKellyPA, et al. Ethnic variation in knee replacement: patient preferences or uninformed disparity. Arch Intern Med. 2005;165(10):1117-1124.
14.
BangHChiuYLMemtsoudisSG, et al. Total hip and total knee arthroplasties: trends and disparities revisited. Am J Orthop (Belle Mead NJ). 2010;39(9):E95-E102.
15.
BanerjeeDIllingworthKDNovicoffWMScaifeSLJonesBKSalehKJ.Ruralvs. urban utilization of total joint arthroplasty. J Arthroplasty. 2013;28(6):888-891.
16.
IbrahimSAStoneRAHanX, et al. Racial/ethnic differences in surgical outcomes in veterans following knee or hip arthroplasty. Arthritis Rheum. 2005;52(10):3143-3151.
17.
HanchateADKapoorAKatzJN, et al. Massachusetts health reform and disparities in joint replacement use: difference in differences study. BMJ. 2015;350:h440.
18.
AdelaniMAKellerMRBarrackRLOlsenMA. The impact of hospital volume on racial differences in complications, readmissions, and emergency department visits following total joint arthroplasty. J Arthroplasty. 2018;33(2):309-315.
19.
FinneganMAShafferRRemingtonAKwongJCurtinCHernandez-BoussardT. Emergency department visits following elective total hip and knee replacement surgery: identifying gaps in continuity of care. J Bone Joint Surg Am. 2017;99(12):1005-1012.
20.
NwachukwuBUKennyADLosinaEChibnikLBKatzJN. Complications for racial and ethnic minority groups after total hip and knee replacement: a review of the literature. J Bone Joint Surg Am. 2010;92(2):338-345.
21.
DunlopDDManheimLMSongJ, et al. Age and racial/ethnic disparities in arthritis-related hip and knee surgeries. Med Care. 2008;46(2):200-208.
22.
EscalanteAEspinosa-MoralesRdel RinconIArroyoRAOlderSA. Recipients of hip replacement for arthritis are less likely to be Hispanic, independent of access to health care and socioeconomic status. Arthritis Rheum. 2000;43(2):390-399.
23.
El BitarYFIllingworthKDScaifeSLHorbergJVSalehKJ. Hospital length of stay following primary total knee arthroplasty: data from the nationwide inpatient sample database. J Arthroplasty. 2015;30(10):1710-1715.
24.
ZhangWLymanSBoutin-FosterC, et al. Racial and ethnic disparities in utilization rate, hospital volume, and perioperative outcomes after total knee arthroplasty. J Bone Joint Surg Am. 2016;98(15):1243-1252.
25.
OttenbacherKJSmithPMIlligSB, et al. Disparity in health services and outcomes for persons with hip fracture and lower extremity joint replacement. Med Care. 2003;41(2):232-241.
26.
Nguyen SmithCReynoldsGLFreshmanB. The effect of acculturation on obesity among foreign-born Asians residing in the United States. J Immigr Minor Health. 2015;17(2):389-399.
27.
ObanaKKDavisJ. Racial disparities in the prevalence of arthritis among native Hawaiians and Pacific Islanders, Whites, and Asians. Hawaii J Med Public Health. 2016;75(6):155-161.
28.
DavittJKKayeLW. Racial/ethnic disparities in access to Medicare home health care: the disparate impact of policy. J Gerontol Soc Work. 2010;53(7):591-612.
29.
NarayanMCScafideKN. Systematic review of racial/ethnic outcome disparities in home health care. J Transcult Nurs. 2017;28(6):598-607.
30.
ChimentiCEIngersollG. Comparison of home health care physical therapy outcomes following total knee replacement with and without subacute rehabilitation. J Geriatr Phys Ther. 2007;30(3):102-108.
31.
FalveyJRBadeMJForsterJE, et al. Home-health-care physical therapy improves early functional recovery of Medicare beneficiaries after total knee arthroplasty. J Bone Joint Surg Am. 2018;100(20):1728-1734.
32.
StoiceaNMagalSKimJKBaiMRogersBBergeseSD. Post-acute transitional journey: caring for orthopedic surgery patients in the United States. Front Med (Lausanne). 2018;5:342.
33.
HaghverdianBAWrightDJSchwarzkopfR. Length of stay in skilled nursing facilities following total joint arthroplasty. The Journal of Arthroplasty. 2017; 32(2): 367-374.
34.
MallinsonTDeutschABatemanJ, et al. Archives of physical medicine and rehabilitation. 2014; 95(2): 209-217.
35.
WeaverFMHughesSLAlmagorO, et al. Comparison of two home care protocols for total joint replacement. J Am Geriatr Soc. 2003;51(4):523-528.
36.
HarrisMDCandandoP. The physical therapist as a member of the home healthcare team: caring for patients with replacements. Home Healthc Nurse. 1998;16(3):153-156.
37.
BergesIMOttenbacherKJSmithPMSmithDOstirGV. Perceived pain and satisfaction with medical rehabilitation after hospital discharge. Clin Rehabil. 2006;20(8):724-730.
38.
ParksMLHebert-BeirneJRojasMTuzzioLNelsonCLBoutin-FosterC. A qualitative study of factors underlying decision making for joint replacement among African Americans and Latinos with osteoarthritis. J Long Term Eff Med Implants. 2014;24(2-3):205-212.
39.
HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality; 2009-2012. https://www.ahrq.gov/data/hcup/index.htmlAccessed March 4.
40.
AdelaniMANunleyRMClohisyJCBarrackRL. Patient perceptions of home health care services after total joint replacement. Orthopedics. 2018;41(5):e713-e717.
41.
PonnusamyKENaseerZEl DafrawyMH, et al. Post-discharge care duration, charges, and outcomes among Medicare patients after primary total hip and knee arthroplasty. J Bone Joint Surg Am. 2017;99(11):e55.
42.
BolenJSchiebLHootmanJM, et al. Differences in the prevalence and severity of arthritis among racial/ethnic groups in the United States, National Health Interview Survey, 2002, 2003, and 2006. Prev Chronic Dis. 2010;7(3):A64-A64.
43.
BradyTJJernickSLHootmanJMSniezekJE. Public health interventions for arthritis: expanding the toolbox of evidence-based interventions. J Womens Health (Larchmt). 2009;18(12):1905-1917.
