San Diego, CA—November 5, 2017
A combination of race and socioeconomic factors play a role in hip replacement outcomes, according to a study at Hospital for Special Surgery (HSS). Researchers found that black patients who lived in areas of economic deprivation did worse in terms of physical function two years after surgery compared to white patients living in impoverished areas. In wealthier neighborhoods, there was no difference in hip replacement outcomes between blacks and whites.
The study was presented at the American College of Rheumatology/Association of Rheumatology Health Professionals annual meeting on November 5 in San Diego.
Using data from a large total hip replacement registry including more than 4,000 patients, researchers compared pain and function two years after surgery between blacks and whites. "To measure community deprivation, we used the census tract variable 'percent of the population with Medicaid insurance coverage,'" explained Susan Goodman, MD, a rheumatologist and director of the Integrative Rheumatology and Orthopedics Center of Excellence at HSS. "We found that black patients living in these areas did worse in terms of physical function than white patients in those neighborhoods."
Researchers evaluated pain and physical function using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), a health status assessment tool. To assess physical function, it includes questions on walking, using stairs, rising from a chair, getting out of bed, putting on socks, shopping and other activities of daily living.
"Although we’re unable to pinpoint a specific reason for the study findings, perhaps the message for doctors is to try to identify patients at risk of a less favorable outcome and provide them with extra support," Dr. Goodman said.
"Patients from impoverished areas also tend to have much worse pain and function at baseline, that is, when they first seek medical care," she added. "Community-based outreach and education may be helpful to ensure that they have access to appropriate care before their situation deteriorates further."
Study title: Social Factors and Racial Disparities in Total Hip Arthroplasty Outcomes [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10).
Authors: Susan M. Goodman, Bella Y. Mehta, Meng Zhang, Jackie Szymonifka, Joseph T. Nguyen, Yuo-Yu Lee, Mark P. Figgie, Michael L. Parks, Shirin A. Dey, Daisy B. Crego, Linda A. Russell, Lisa A. Mandl and Anne R. Bass, all at Hospital for Special Surgery.
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the ninth consecutive year) and No. 3 in rheumatology by U.S.News & World Report (2018-2019). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.