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Racial Disparities in Septic and Aseptic Total Knee Replacement Revision Risk: A Study Using Four State-wide Inpatient Databases

Approximately 4% of total knee replacement (TKR) patients require a revision surgery within five years. African Americans are 40% more likely to undergo TKR revision than whites, but whether racial disparities exist for both septic and aseptic TKR revision risk is unknown. Researchers set out to determine if racial disparities exist for both septic (due to infection) and aseptic (due to another cause, such as instability) revision surgery. They also explored whether racial disparities in TKR revision risk actually arise from poverty.

The investigators found that African American patients were at much higher risk of aseptic TKR revision than white patients, but that there were only modest racial disparities in the risk of septic TKR revision. Community poverty did not increase the risk of septic or aseptic TKR revision in either African Americans or whites.

Of note, low annual hospital TKR volume was a risk factor for septic TKR revision in both African American and white patients, and also increased the risk of aseptic TKR revision in white patients. Why the risk of aseptic revision was high for African Americans attending high TKR volume hospitals warrants further study, according to the researchers.

About HSS

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 tenth consecutive year), No. 3 in rheumatology by U.S. News & World Report (2019-2020), and named a leader in pediatric orthopedics by U.S. News & World Report “Best Children’s Hospitals” list (2019-2020). 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 addition, HSS will be opening a new facility in Florida in early 2020. In 2018, HSS provided care to 139,000 patients and performed more than 32,000 surgical procedures, and people from all 50 U.S. states and 80 countries travelled to receive care at HSS. There were more than 37,000 pediatric visits to the HSS Lerner Children’s Pavilion for treatment by a team of interdisciplinary experts. 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 HSS Education Institute is the world’s leading provider of education 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.