Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 1/2014

01-01-2014 | Symposium: 2013 Knee Society Proceedings

Impact of Socioeconomic Factors on Outcome of Total Knee Arthroplasty

Authors: Robert L. Barrack, MD, Erin L. Ruh, MS, Jiajing Chen, MPH, Adolph V. Lombardi Jr, MD, Keith R. Berend, MD, Javad Parvizi, MD, FRCS, Craig J. Della Valle, MD, William G. Hamilton, MD, Ryan M. Nunley, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 1/2014

Login to get access

Abstract

Background

Few data exist regarding the impact of socioeconomic factors on results of current TKA in young patients. Predictors of TKA outcomes have focused primarily on surgical technique, implant details, and individual patient clinical factors. The relative importance of these factors compared to patient socioeconomic status is not known.

Questions/purposes

We determined whether (1) socioeconomic factors, (2) demographic factors, or (3) implant factors were associated with satisfaction and functional outcomes after TKA in young patients.

Methods

We surveyed 661 patients (average age, 54 years; range, 18–60 years; 61% female) 1 to 4 years after undergoing modern primary TKA for noninflammatory arthritis at five orthopaedic centers. Data were collected by an independent third party with expertise in collecting healthcare data for state and federal agencies. We examined specific questions regarding satisfaction, pain, and function after TKA and socioeconomic (household income, education, employment) and demographic (sex, minority status) factors. Multivariable analysis was conducted to examine the relative importance of these factors for each outcome of interest.

Results

Patients reporting incomes of less than USD 25,000 were less likely to be satisfied with TKA outcomes and more likely to have functional limitations after TKA than patients with higher incomes; no other socioeconomic factors were associated with satisfaction. Women were less likely to be satisfied and more likely to have functional limitations than men, and minority patients were more likely to have functional limitations than nonminority patients. Implants were not associated with outcomes after surgery.

Conclusions

Socioeconomic factors, in particular low income, are more strongly associated with satisfaction and functional outcomes in young patients after TKA than demographic or implant factors. Future studies should be directed to determining the causes of this association, and studies of clinical results after TKA should consider stratifying patients by socioeconomic status.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Appendix
Available only for authorised users
Literature
1.
Ayers DC, Franklin PD, Ploutz-Snyder R, Boisvert CB. Total knee replacement outcome and coexisting physical and emotional illness. Clin Orthop Relat Res. 2005;440:157–161.PubMedCrossRef
2.
Baker PN, van der Meulen JH, Lewsey J, Gregg PJ; National Joint Registry for England and Wales. The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg Br. 2007;89:893–900.PubMedCrossRef
3.
Barrack RL, Ruh EL, Berend ME, Della Valle CJ, Engh CA Jr, Parvizi J, Clohisy JC, Nunley RM. Do Young, Active Patients Perceive Advantages After Surface Replacement Compared to Cementless Total Hip Arthroplasty? Clin Orthop Relat Res. 2013 March 19 [Epub ahead of print].
4.
Blaha JD. The rationale for a total knee implant that confers anteroposterior stability throughout range of motion. J Arthroplasty. 2004;19:22–26.PubMedCrossRef
5.
Bonnin MP, Basiglini L, Archbold HA. What are the factors of residual pain after uncomplicated TKA? Knee Surg Sports Traumatol Arthrosc. 2011;19:1411–1417.PubMedCrossRef
6.
Booth RE Jr. Sex and the total knee: gender-sensitive designs. Orthopedics. 2006;29:836–838.PubMed
7.
Bourne R. A gender-specific prosthesis was similar to a standard prosthesis in women having total knee replacement. J Bone Joint Surg Am. 2011;93:396.PubMedCrossRef
8.
Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010;468:57–63.PubMedCentralPubMedCrossRef
9.
Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, Stanos SP, Houle T. Predicting total knee replacement pain: a prospective, observational study. Clin Orthop Relat Res. 2003;416:27–36.PubMedCrossRef
10.
Butler RA, Rosenzweig S, Myers L, Barrack RL. The Frank Stinchfield Award. The impact of socioeconomic factors on outcome after THA: a prospective, randomized study. Clin Orthop Relat Res. 2011;469:339–347.CrossRef
11.
Cai X, Cram P, Vaughan-Sarrazin M. Are African American patients more likely to receive a total knee arthroplasty in a low-quality hospital? Clin Orthop Relat Res. 2012;470:1185–1193.PubMedCentralPubMedCrossRef
12.
Centers for Disease Control and Prevention. Prevalence of cholesterol screening and high blood cholesterol among adults – United States, 2005, 2007, and 2009. MMWR Morb Mortal Wkly Rep. 2012;61:697–702.
13.
14.
Chandran N, Amirouche F, Gonzalez MH, Hilton KM, Barmada R, Goldstein W. Optimisation of the posterior stabilised tibial post for greater femoral rollback after total knee arthroplasty—a finite element analysis. Int Orthop. 2009;33:687–693.PubMedCentralPubMedCrossRef
15.
Chatman AB, Hyams SP, Neel JM, Binkley JM, Stratford PW, Schomberg A, Stabler M. The Patient-Specific Functional Scale: measurement properties in patients with knee dysfunction. Phys Ther. 1997;77:820–829.PubMed
16.
Dennis DA, Komistek RD. Kinematics of mobile-bearing total knee arthroplasty. Instr Course Lect. 2005;54:207–220.PubMed
17.
Dunlop DD, Manheim LM, Song J, Sohn MW, Feinglass JM, Chang HJ, Chang RW. Age and racial/ethnic disparities in arthritis-related hip and knee surgeries. Med Care. 2008;46:200–208.PubMedCrossRef
18.
Endres S. High-flexion versus conventional total knee arthroplasty: a 5-year study. J Orthop Surg (Hong Kong). 2011;19:226–229.PubMed
19.
Epstein AJ, Gray BH, Schlesinger M. Racial and ethnic differences in the use of high-volume hospitals and surgeons. Arch Surg. 2010;145:179–186.PubMedCrossRef
20.
Fisher DA, Dierckman B, Watts MR, Davis K. Looks good but feels bad: factors that contribute to poor results after total knee arthroplasty. J Arthroplasty. 2007;22:39–42.PubMedCrossRef
21.
Franklin PD, Li W, Ayers DC. The Chitranjan Ranawat Award. Functional outcome after total knee replacement varies with patient attributes. Clin Orthop Relat Res. 2008;466:2597–2604.PubMedCentralPubMedCrossRef
22.
Freburger JK, Holmes GM, Ku LJ, Cutchin MP, Heatwole-Shank K, Edwards LJ. Disparities in post-acute rehabilitation care for joint replacement. Arthritis Care Res (Hoboken). 2011;63:1020–1030.PubMedCentralPubMedCrossRef
23.
Goyal N, McKenzie J, Sharkey PF, Parvizi J, Hozack WJ, Austin MS. The 2012 Chitranjan Ranawat Award. Intraarticular analgesia after TKA reduces pain: a randomized, double-blinded, placebo-controlled, prospective study. Clin Orthop Relat Res. 2013;471:64–75.PubMedCrossRef
24.
Hanchate AD, Zhang Y, Felson DT, Ash AS. Exploring the determinants of racial and ethnic disparities in total knee arthroplasty: health insurance, income, and assets. Med Care. 2008;46:481–488.PubMedCentralPubMedCrossRef
25.
Horn KK, Jennings S, Richardson G, Vliet DV, Hefford C, Abbott JH. The Patient-Specific Functional Scale: psychometrics, clinimetrics, and application as a clinical outcome measure. J Orthop Sports Phys Ther. 2012;42:30–42.PubMedCrossRef
26.
Ibrahim SA, Stone RA, Han X, Cohen P, Fine MJ, Henderson WG, Khuri SF, Kwoh CK. Racial/ethnic differences in surgical outcomes in veterans following knee or hip arthroplasty. Arthritis Rheum. 2005;52:3143–3151.PubMedCrossRef
27.
28.
Jacobs W, Anderson P, Limbeek J, Wymenga A. Mobile bearing vs fixed bearing prostheses for total knee arthroplasty for post-operative functional status in patients with osteoarthritis and rheumatoid arthritis. Cochrane Database Syst Rev. 2004;2:CD003130.
29.
Jacobs WC, Clement DJ, Wymenga AB. Retention versus sacrifice of the posterior cruciate ligament in total knee replacement for treatment of osteoarthritis and rheumatoid arthritis. Cochrane Database Syst Rev. 2005;4:CD004803.
30.
Jolles BM, Grzesiak A, Eudier A, Dejnabadi H, Voracek C, Pichonnaz C, Aminian K, Martin E. A randomised controlled clinical trial and gait analysis of fixed- and mobile-bearing total knee replacements with a five-year follow-up. J Bone Joint Surg Br. 2012;94:648–655.PubMedCrossRef
31.
Kim YH, Kim JS, Choe JW, Kim HJ. Long-term comparison of fixed-bearing and mobile-bearing total knee replacements in patients younger than fifty-one years of age with osteoarthritis. J Bone Joint Surg Am. 2012;94:866–873.PubMed
32.
Kim YH, Kook HK, Kim JS. Comparison of fixed-bearing and mobile-bearing total knee arthroplasties. Clin Orthop Relat Res. 2001;392:101–115.PubMedCrossRef
33.
Kolisek FR, Mont MA, Costa CR, Johnson AJ, Jaggard CE. A comparison study of two cruciate-retaining total knee designs: a preliminary report. Surg Technol Int. 2011;XXI:194–198.
34.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.PubMedCrossRef
35.
Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res. 2009;467:2606–2612.PubMedCentralPubMedCrossRef
36.
Lavernia CJ, Alcerro JC, Brooks LG, Rossi MD. Mental health and outcomes in primary total joint arthroplasty. J Arthroplasty. 2012;27:1276–1282.PubMedCrossRef
37.
Lavernia CJ, Alcerro JC, Contreras JS, Rossi MD. Ethnic and racial factors influencing well-being, perceived pain, and physical function after primary total joint arthroplasty. Clin Orthop Relat Res. 2011;469:1838–1845.PubMedCentralPubMedCrossRef
38.
Lieberman JR, Dorey F, Shekelle P, Schumacher L, Thomas BJ, Kilgus DJ, Finerman GA. Differences between patients’ and physicians’ evaluations of outcome after total hip arthroplasty. J Bone Joint Surg Am. 1996;78:835–838.PubMed
39.
Likert R. A technique for the measurement of attitudes. Arch Psychol. 1932;22:1–55.
40.
41.
Lozano-Calderon SA, Shen J, Doumato DF, Greene DA, Zelicof SB. Cruciate-retaining vs posterior-substituting inserts in total knee arthroplasty: functional outcome comparison. J Arthroplasty. 2013;28:234–242.el.
42.
MacDonald SJ, Charron KD, Bourne RB, Naudie DD, McCalden RW, Rorabeck CH. The John Insall Award. Gender-specific total knee replacement: prospectively collected clinical outcomes. Clin Orthop Relat Res. 2008;466:2612–2616.PubMedCentralPubMedCrossRef
43.
Maloney WJ. National Joint Replacement Registries: has the time come? J Bone Joint Surg Am. 2001;83:1582–1585.PubMed
44.
Meftah M, Wong AC, Nawabi DH, Yun RJ, Ranawat AS, Ranawat CS. Pain management after total knee arthroplasty using a multimodal approach. Orthopedics. 2012;35:e660–e664.PubMedCrossRef
45.
Mont MA, Mayerson JA, Krackow KA, Hungerford DS. Total knee arthroplasty in patients receiving Workers’ Compensation. J Bone Joint Surg Am. 1998;80:1285–1290.PubMed
46.
Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award. Patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res. 2006;452:35–43.PubMedCrossRef
47.
Nunley RM, Ruh EL, Zhang Q, Della Valle CJ, Engh CA Jr, Berend ME, Parvizi J, Clohisy JC, Barrack RL. Do patients return to work after hip arthroplasty surgery? J Arthroplasty. 2011;26(6 suppl):92–98.e1-3.
48.
Nwachukwu BU, Kenny AD, Losina E, Chibnik LB, Katz JN. Complications for racial and ethnic minority groups after total hip and knee replacement: a review of the literature. J Bone Joint Surg Am. 2010;92:338–345.PubMedCentralPubMed
49.
Pagnano MW, Trousdale RT, Stuart MJ, Hanssen AD, Jacofsky DJ. Rotating platform knees did not improve patellar tracking: a prospective, randomized study of 240 primary total knee arthroplasties. Clin Orthop Relat Res. 2004;428:221–227.PubMedCrossRef
50.
Price AJ, Longino D, Rees J, Rout R, Pandit H, Javaid K, Arden N, Cooper C, Carr AJ, Dodd CA, Murray DW, Beard DJ. Are pain and function better measures of outcome than revision rates after TKR in the younger patient? Knee. 2010;17:196–199.PubMedCrossRef
51.
Radler BT, Ryff CD. Who participates? Accounting for longitudinal retention in the MIDUS national study of health and well-being. J Aging Health. 2010;22:307–331.PubMedCentralPubMedCrossRef
52.
Rahman MM, Kopec JA, Sayre EC, Greidanus NV, Aghajanian J, Anis AH, Cibere J, Jordan JM, Badley EM. Effect of sociodemographic factors on surgical consultations and hip or knee replacements among patients with osteoarthritis in British Columbia, Canada. J Rheumatol. 2011;38:503–509.CrossRef
53.
Riddle DL, Wade JB, Jiranek WA, Kong X. Preoperative pain catastrophizing predicts pain outcome after knee arthroplasty. Clin Orthop Relat Res. 2010;468:798–806.PubMedCentralPubMedCrossRef
54.
Santaguida PL, Hawker GA, Hudak PL, Glazier R, Mahomed NN, Kreder HJ, Coyte PC, Wright JG. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg. 2008;51:428–436.PubMedCentralPubMed
55.
Scuderi GR, Hedden DR, Maltry JA, Traina SM, Sheinkop MB, Hartzband MA. Early clinical results of a high-flexion, posterior-stabilized, mobile-bearing total knee arthroplasty: a US investigational device exemption trial. J Arthroplasty. 2012;27:421–429.PubMedCrossRef
56.
Singh JA, O’Byrne M, Harmsen S, Lewallen D. Predictors of moderate-severe functional limitation after primary total knee arthroplasty (TKA): 4701 TKAs at 2-years and 2935 TKAs at 5-years. Osteoarthritis Cartilage. 2010;18:515–521.PubMedCrossRef
57.
Singh JA, O’Byrne MM, Colligan RC, Lewallen DG. Pessimistic explanatory style: a psychological risk factor for poor pain and functional outcomes two years after knee replacement. J Bone Joint Surg Br. 2010;92:799–806.PubMedCrossRef
58.
Skinner J, Zhou W, Weinstein J. The influence of income and race on total knee arthroplasty in the United States. J Bone Joint Surg Am. 2006;88:2159–2166.PubMedCentralPubMedCrossRef
59.
Song EK, Jung WB, Yoon TR, Park KS, Seo HY, Seon JK. Comparison of outcomes after bilateral simultaneous total knee arthroplasty using gender-specific and unisex knees. J Arthroplasty. 2012;27:226–231.PubMedCrossRef
60.
Stratford P, Gill C, Westaway M, Binkley J. Assessing disability and change on individual patients: a report of a patient specific measure. Physiother Can. 1995;47:258–263.CrossRef
61.
Thomsen MG, Husted H, Bencke J, Curtis D, Holm G, Troelsen A. Do we need a gender-specific total knee replacement? A randomised controlled trial comparing a high-flex and a gender-specific posterior design. J Bone Joint Surg Br. 2012;94:787–792.PubMedCrossRef
62.
Ulrich SD, Mont MA, Bonutti PM, Seyler TM, Marker DR, Jones LC. Scientific evidence supporting computer-assisted surgery and minimally invasive surgery for total knee arthroplasty. Expert Rev Med Devices. 2007;4:497–505.PubMedCrossRef
63.
Wainwright C, Theis JC, Garneti N, Melloh M. Age at hip or knee joint replacement surgery predicts likelihood of revision surgery. J Bone Joint Surg Br. 2011;93:1411–1415.PubMedCrossRef
64.
Walker PS, Heller Y, Cleary DJ, Yildirim G. Preclinical evaluation method for total knees designed to restore normal knee mechanics. J Arthroplasty. 2011;26:152–160.PubMedCrossRef
Metadata
Title
Impact of Socioeconomic Factors on Outcome of Total Knee Arthroplasty
Authors
Robert L. Barrack, MD
Erin L. Ruh, MS
Jiajing Chen, MPH
Adolph V. Lombardi Jr, MD
Keith R. Berend, MD
Javad Parvizi, MD, FRCS
Craig J. Della Valle, MD
William G. Hamilton, MD
Ryan M. Nunley, MD
Publication date
01-01-2014
Publisher
Springer US
Published in
Clinical Orthopaedics and Related Research® / Issue 1/2014
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-013-3002-y

Other articles of this Issue 1/2014

Clinical Orthopaedics and Related Research® 1/2014 Go to the issue

Symposium: 2013 Knee Society Proceedings

The Effect of Geometric Variations in Posterior-stabilized Knee Designs on Motion Characteristics Measured in a Knee Loading Machine

Symposium: 2013 Knee Society Proceedings

The Mark Coventry Award: Higher Tissue Concentrations of Vancomycin With Low-dose Intraosseous Regional Versus Systemic Prophylaxis in TKA

Symposium: 2013 Knee Society Proceedings

Comparison of Total Knee Arthroplasty With Highly Congruent Anterior-stabilized Bearings versus a Cruciate-retaining Design

Letter to the Editor

Letter to the Editor: Mid-America Orthopaedic Association Physician in Training Award: Surgical Technique: Pediatric Supracondylar Humerus Fractures: A Technique to Aid Closed Reduction

Symposium: 2013 Knee Society Proceedings

Editorial Comment: Symposium: 2013 Knee Society Proceedings

Symposium: 2013 Knee Society Proceedings

Do Patients Return to Work After Total Knee Arthroplasty?