The study isn’t a controlled experiment designed to prove whether or how differences in surgery options or outcomes between black and white people might translate into differences in quality of life or disease burden. Estimates from a computer model also may not reflect what would happen in a real population of patients.
Nor does it address why there are racial disparities in the proportion of patients who are offered, or who accept knee replacement in the first place.
The study doesn’t account for patient preferences, and some previous research suggests that black people may be less willing to undergo knee replacement procedures, said Dr. Said Ibrahim, a researcher at Weill Cornell Medicine in New York City who wasn’t involved in the study.
“Access to insurance or lower prevalence of knee osteoarthritis among minority patients is the not the reason,” Ibrahim said by email. “Similarly, it is not clear that orthopedic surgeons, who are predominantly white men, are less willing to operate on minority patients with health insurance.”
Instead, patient preference may play a role, Ibrahim said. Minority patients may have concerns about complications and they may be more likely to receive treatment at low-quality hospitals where surgeons don’t do as many knee replacements and get worse outcomes, he added.
“This new study is very important in that it shows for the first time that lower utilization of this effective treatment is associated with quality of life price,” Ibrahim said. “This matters to patients, because the two most important indications for this treatment are pain control and quality of life improvement.”
Reference
- Kerman HM, Smith SR, Smith KC, et al. Disparities in total knee replacement: Population losses in quality-adjusted life years due to differential offer, acceptance, and complication rates for Black Americans. Arthritis Care & Research (Hoboken). 2018 Jan 24. [Epub ahead of print]
