Race and ethnicity predict short-term but not long-term complications after primary total hip arthroplasty

Abstract

Introduction:

There is increased awareness of socioeconomic disparities among total hip arthroplasty (THA) patients. Most studies contain small sample sizes and few control for confounding variables. This study aims to evaluate postoperative outcomes and survivorship after THA in patients of different races/ethnicities.

Methods:

Patients who underwent a primary THA were identified in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Patients were stratified into 4 groups: White, Black, Hispanic, or Asian. Categorical variables and continuous variables were compared, and revision free survival was calculated using Kaplan Meier survival analysis. Multivariate Cox proportional hazard regression was used to calculate revision hazard ratios.

Results:

In total, 203,443 White, 19,282 Black, 11,669 Hispanic, and 2179 Asian patients were identified. Length of stay, discharge disposition, postoperative anaemia, blood transfusions, 3-month re-admissions and emergency room visits, and 3- and 12-month periprosthetic joint infection rates were all higher in Black and Hispanic patients compared to White (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.014, p = 0.003, respectively); however, 12-month mortality rates were similar. Cox proportional hazard regression analysis demonstrated that Black patients had a lower risk of revision compared to White patients (HR 0.90; 95% CI, 0.82–0.98, p = 0.021). There were no significant differences in the cumulative revision event rate up to 10 years postoperatively.

Conclusions:

Non-White patients are significantly more likely to have worse short-term outcomes and complications. However, overall rates of revision at 1 year are similar across these groups, with a slightly lower rate of revision in Black patients after controlling for confounding factors.