Rich Or Poor: Total Knee Arthroplasty Outcomes Are The Same

Main Category: Bones / Orthopedics
Also Included In: Arthritis / Rheumatology;  Public Health
Article Date: 17 Feb 2007 - 0:00 PDT

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Previous research has shown that socioeconomic status has a negative impact on patient outcomes. But a new study presented at the 74th Annual Meeting of the American Academy of Orthopaedic Surgeons shows that lower income, less educated patients can have the same outcomes after total knee arthroplasty (TKA) as any other socioeconomic group.

"We studied 974 patients with osteoarthritis who were going to undergo TKA at 13 medical centers in four countries. Although the patients with lower incomes had a greater need for TKA, the level of income and educational status did not affect the final outcome of the procedures," said Edward T. Davis, M.Sc., FRCS, a clinical fellow at St. Michael's Hospital in Toronto. "Patients with lower incomes appeared able to compensate for their worse preoperative score and obtain similar outcomes postoperatively."

Dr. Davis said that limited studies have been undertaken into the effects of socioeconomic factors on patient outcomes following total joint replacement. Preoperative function has been shown to be one of the strongest determinates of functional outcome after total joint arthroplasty, specifically after TKA Factors such as mental health status, co-morbid medical conditions; patient expectations; gender; and type of arthritis also have been correlated with outcome.

"Studies have shown that patients who had less education and lower income have worse osteoarthritis, arthritic symptoms and disability, causing a greater potential need for hip and knee arthroplasty," said Dr. Davis. "They were approximately twice as likely to need TKA and were less likely to be receiving services."

"The reasons patients in the lower socioeconomic groups are disadvantaged in the health care system is multi-factorial," said Dr. Davis. "Disadvantaged patients may not understand health literature and risk factors; may not recognize symptoms; or may not understand the benefits of exercise, thus reducing their motivation to adhere to exercise recommendations, all which may negatively affect outcomes. On the other side of spectrum, health care providers may stereotype patients and spend less time with them compared to well-educated patients.

The researchers said that barriers to TKA may include patient factors such as difficulties in negotiating the health care system, an unwillingness and lack of desire to receive treatment, as well as the potential differences in physicians' management of patients in both referral for surgery and decision to operate.

American Academy of Orthopaedic Surgeons
http://www.aaos.org/

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