African Americans who undergo total knee replacement (TKR) surgery experience a significant loss of quality-adjusted life-years (QALYs), which is a result of both racial disparities in TKR use and increased postoperative complications, according to a study published in Arthritis Care & Research.

The investigators sought to estimate QALYs lost among African Americans with knee osteoarthritis (OA) because of differences in surgery offering, acceptance, or postoperative complications. They used the Osteoarthritis Policy Model, a computer simulation of knee OA, to predict QALY outcomes among African Americans and white patients with knee OA who did or did not undergo TKR surgery.

Per person QALYs obtained from TKR were estimated on the basis of the difference between QALYs with current TKR use and QALYs when no TKR surgery was performed. Average QALY losses in African Americans were estimated as the difference in rates between QALYs gained with TKR surgery among white patients and QALYs gained with TKR surgery among African Americans.

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The results showed that among African American men and women, a total of 64,100 QALYs are gained from current TKR use. If offers and complication rates of white Americans were applied to African Americans, they would gain an additional 72,000 QALYs.

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Because these additional gains are unrealized, this is considered a loss of 72,000 QALYs. Overall, African Americans lose a total of 67,500 QALYs because of low offer, 15,800 QALYs because of low acceptance, and 26,000 QALYs because of higher complication rates.

The findings of this study highlight the need for programs that are designed to decrease disparities in joint replacement use among various populations.


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 [published online January 24, 2018]. Arthritis Care Res (Hoboken). doi:10.1002/acr.23484