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Complications for Racial and Ethnic Minority Groups After Total Hip and Knee ReplacementA Review of the Literature
Benedict U. Nwachukwu, BA1; Adrian D. Kenny, MD2; Elena Losina, PhD2; Lori B. Chibnik, PhD, MPH2; Jeffrey N. Katz, MD, MSc2
1 Harvard Medical School, Holmes Society, 260 Longwood Avenue, 2nd Floor, Boston, MA 02115. E-mail address: Benedict_Nwachukwu@hms.harvard.edu
2 Division of Rheumatology, Immunology and Allergy (A.D.K., E.L., L.B.C., and J.N.K.), and Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery (E.L. and J.N.K.), Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Doris Duke Charitable Foundation and less than $10,000 from the National Institutes of Health. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Feb 01;92(2):338-345. doi: 10.2106/JBJS.I.00510
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Total hip and knee replacement reduces disability associated with lower extremity osteoarthritis. It has been shown that racial and ethnic minority groups underutilize these procedures; however, little information exists on postoperative outcomes for ethnic minorities.


We conducted a systematic review of the literature to compile population-based or multicenter studies on early postoperative outcomes after total hip and knee replacement in racial and ethnic minorities.


Nine studies met the inclusion criteria. Among the nine eligible studies, four examined total knee replacement, three examined total hip replacement, and two examined both. Two studies investigated mortality after total knee replacement, and one found that blacks had an increased risk of mortality. Three studies investigated infection after total knee replacement; all found an increased risk in blacks and Hispanics. Four studies examined non-infection-related complications after total knee replacement, and all four found that nonwhites had an increased risk of complications. Two studies investigated mortality after total hip replacement; one of these found that, for primary hip replacement, blacks had an increased risk of mortality.


There is a paucity of research on outcomes after orthopaedic procedures for racial and ethnic minority groups. On the basis of the available literature, racial and ethnic minority groups appear to have a higher risk for early complications (those occurring within ninety days), particularly joint infection, after total knee replacement and perhaps a higher risk of mortality after total hip replacement.

Level of Evidence: 

Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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