Impact of Race/Ethnicity in OA Treatment

Thurston Arthritis Research Center, University of North Carolina, 3300 Doc J. Thurston, Jr. Bldg. CB#7280, Chapel Hill, NC 27599-7280 USA.
HSS Journal 02/2012; 8(1):39-41. DOI: 10.1007/s11420-011-9256-6
Source: PubMed
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    • "Likewise, whilst black and Asian patients have poorer outcomes in terms of PROMs and satisfaction, similar differences are observed TKR12. The reasons for these differences are complicated and may relate to differences in social support, pain perception and access to arthroplasty38. Black and Asian patients may present later in the disease process and therefore have more severe preoperative disease27. In this study, Black and Asian patients had significantly worse preoperative OKS than white patients. "
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    ABSTRACT: Objective Unicompartmental Knee Replacement (UKR) has important advantages over total knee replacement (TKR) but has a higher revision rate. Outcomes vary between centres, suggesting that risk factors for revision may be modifiable with changes to patient selection or operative technique. The objective of this study was to determine factors affecting revision, patient-reported outcome and satisfaction following UKR. Method 25,982 cases from three national databases were analysed. Multilevel multivariable regression models were used to examine the effect of patient and surgical factors on implant survival, patient-reported outcome and satisfaction at six months and eight years following UKR. Results Of the 25,982 cases, 3,862 (14.9%) had pre-operative and six-month Oxford Knee Scores (OKS). Eight-year survival was 89.1% (95% CI 88.3-89.9). OKS increased from 21.9 (SD 7.6) to 37.5 (SD 9.5). Age (HR 0.96 (95%CI 0.96-0.97) per year), male gender (HR 0.86 (95%CI 0.76-0.96)), unit size (HR 0.92 (95%CI 0.86-0.97) per case up to 40 cases/year) and operating surgeon grade (HR 0.78 (95%CI 0.67-0.91) if consultant) predicted improved implant survival. Older patients (≤75 years), and those with lower deprivation levels had superior OKS and satisfaction (adjusted mean difference 0.14 (95%CI 0.09-0.20) points per year of age and 0.93 (95%CI 0.60-1.27) per quintile of deprivation). Ethnicity, anxiety and co-morbidities also affected patient-reported outcome. Conclusions This study has identified important predictors of revision and patient-reported outcome following UKR. Older patients, who are least likely to be offered UKR, may derive the greatest benefits. Improved understanding of these factors may improve the long-term outcomes of UKR.
    Osteoarthritis and Cartilage 09/2014; 22(9). DOI:10.1016/j.joca.2014.07.006 · 4.17 Impact Factor
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    ABSTRACT: To determine whether knee cartilage composition differs between African-American and Caucasian-American women at risk for Osteoarthritis using in-vivo 3 Tesla MRI T2 relaxation time measurements. Right knee MRI studies of 200 subjects (100 African-American women, and 100 closely matched Caucasian-American women) were selected from the Osteoarthritis Initiative. Knee cartilage was segmented in the patellar (PAT), medial and lateral femoral (MF/LF), and medial and lateral tibial compartments (MT/LT)). Mean T2 relaxation time values per compartment and per whole joint cartilage were generated and analyzed spatially via laminar and grey-level co-occurrence matrix texture methods. Presence and severity of cartilage lesions per compartment were graded using a modified WORMS grading. Statistical analysis employed paired t- and McNemar testing. While African-American women and Caucasian-Americans had similar WORMS cartilage lesion scores (p=0.970), African-Americans showed significantly lower mean T2 values (∼1ms difference; ∼0.5SD) than Caucasian-Americans in the whole knee cartilage (p<0.001), and in the subcompartments (LF: p=0.001, MF: p<0.001, LT: p=0.019, MT: p=0.001) and particularly in the superficial cartilage layer (whole cartilage: p<0.001, LF: p<0.001, MF: p<0.001, LT: p=0.003, MT: p<0.001). T2 texture parameters were also significantly lower in the whole joint cartilage of African-Americans than in Caucasian-Americans (variance: p=0.001; contrast: p=0.018). In analyses limited to matched pairs with no cartilage lesions in a given compartment, T2 values remained significantly lower in African-Americans. Using T2 relaxation time as a biomarker for the cartilage collagen network, our findings suggest racial differences in the biochemical knee cartilage composition between African-American and Caucasian-American women. Copyright © 2015. Published by Elsevier Ltd.
    Osteoarthritis and Cartilage 04/2015; 23(9). DOI:10.1016/j.joca.2015.04.023 · 4.17 Impact Factor

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