Racial and Socioeconomic Disparities in the Utilization of TKA Among Patients with Posttraumatic Knee Osteoarthritis: Estimates from the United States National Inpatient Sample, 2011-2018

Advanced posttraumatic osteoarthritis (PTOA) of the knee is a cause of substantial disability, particularly in younger individuals, and the treatment of choice is total knee arthroplasty (TKA). Racial and socioeconomic disparities exist in the use of TKA, but, to our knowledge, there have been no studies examining these disparities among patients with PTOA. METHODS: We performed chi-square and logistic regression analyses on data from the Nationwide Inpatient Sample (NIS). The outcome of interest was the rate of TKA utilization, and the primary predictors were racial/ethnic group and insurance status. The regression models were adjusted for age, sex, household income, and Charlson Comorbidity Index (CCI). RESULTS: The odds of receiving TKA for Black patients (odds ratio [OR] = 0.55; 95% confidence interval [CI], 0.48 to 0.62) and Hispanic patients (OR = 0.53; 95% CI, 0.46 to 0.62) were lower compared with White patients. Patients with Medicare (OR = 0.51; 95% CI, 0.46 to 0.57), those with Medicaid (OR = 0.48; 95% CI, 0.42 to 0.55), and those who self-paid (OR = 0.91, 95% CI: 0.14 to 0.25) had significantly lower odds of TKA compared with those with private insurance. CONCLUSIONS: Black and Hispanic patients are less likely than White patients to utilize TKA, and patients with private insurance are more likely to utilize TKA. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.