Knee replacement surgery has the potential to turn back the clock
for people suffering from severe joint pain that limits their
mobility and makes it hard for them to complete daily tasks. While
surgery can’t return people to the same level of comfort and
function they had before they developed arthritis, it can make them
feel much less disabled.
Based on the current rates of knee replacement surgery among all
black and white men and women in the U.S. who might qualify for the
procedure, researchers estimated that blacks are potentially missing
out on tens of thousands of years with better quality of life
compared to their white counterparts, according to the report in
Arthritis Care & Research.
The researchers created a computer model to estimate the effect of
knee replacement on what’s known as quality-adjusted life years (QALY),
which is a measure of both functional ability and its impact on
overall quality of life, and takes into account total expected
duration of life.

“Underutilization of the highly successful surgery leads to drastic
losses of quality adjusted life years among racial minorities,” said
senior study author Elena Losina, an orthopedics researcher at
Brigham and Women’s Hospital and Harvard Medical School in Boston.
In the computer simulation developed by the researchers,
hypothetical patients were 66 years old, on average, and usually had
moderate to severe knee osteoarthritis. This is a typical age and
symptom burden experienced by people who get surgery in the U.S.
Then, the study team estimated that about 23 percent of white
patients and 12 percent of black patients would be offered total
knee replacement surgery, based on findings from previous research
done in the Veterans Affairs healthcare system.
Based on results from a different study, researchers then estimated
that 83 percent of white men and 59 percent of black men offered
surgery decided to get the operation, as did 78 percent of white
women and 64 percent of black women.
They also calculated probabilities of complications like heart
attacks, pneumonia, a blockage in the pulmonary artery or death in
the first year after surgery.
After plugging in all these numbers, researchers calculated that
based on current rates of knee replacement, there is a QALY gain of
4.8 per 100 black men, 8.2 per 100 black women, 12.6 per 100 white
men and 15.7 per 100 white women.
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Put another way, black men and women gain QALY as a result of knee
replacements, but they could be gaining many more high-quality years
if they were offered and accepted surgery at the same rates as white
patients and had similar complication rates, the authors conclude.
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.”
SOURCE: http://bit.ly/2ENZjmJ Arthritis Care & Research, online
January 24, 2018
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