Racial variations in total joint arthroplasty in Western New York: A retrospective review

Introduction: This study aimed to quantify disparities in total joint arthroplasty (TJA) utilization and outcomes in Erie County, NY. Methods: Retrospective review included adult patients who received TJA between January 2018–December 2021 by one orthopaedic practice in Erie County, NY. Patient demographics and patient reported outcome measures (PROMs) were collected. Social determinants of health data (SDoH) were extrapolated from ZIP-code level data from the U.S. Census Bureau and American Community Data Survey, 5-year Estimates 2018–2022. Results: The TJA cohort (n 6974) was not racially representative of the general population, with 88.11 % of patients served identifying as white vs. 76.5 % within the general population (p < 0.001). Median household income (MHI) was higher (p < 0.001), poverty rate lower (p < 0.001), Bachelor's degree attainment lower (p < 0.001), and percent without healthcare lower (p < 0.001) than the average population; however, the effect sizes of comparisons of SDoH across patient between the study population and the general population were small. Within those patients treated with TJA, effect size comparisons of SDoH across race, specifically MHI, poverty rate, and insurance rates, were large with consideration to Black/African American vs. White patients. Significant variations in preoperative and postoperative PROMS, including postoperative rate of improvement, were described comparing patient race and poverty status examining general scores, pain scores, and joint specific scores. However, while statistically significant, the differences in PROMs described largely did not reach thresholds correlating to clinical significance. Conclusion: There exist racial disparities in TJA utilization in the described patient population. Correlative disparities in SDoH in the treated cohort were reflective of the general surrounding population, which may explain these differences in utilization. PROM measures significantly varied per race and poverty status; however, this warrants future study, as these differences may not have reached clinical significance.