Knee Surgery? Not For Everyone

Demographic data can be a double-edged sword in the world of medicine. In the wrong hands, it may be treated as evidence of an underlying health liability, or poor lifestyle choices. In the right hands, it can guide us toward more responsible medical decisions predicated on the idea that not every patient population is precisely the same.

Consider this recent study of total knee replacement (TKR) surgeries, which resulted in a startling set of findings, including:

In comparison to the white population, minorities had lower rates of TKR utilization.
Minorities were less likely to undergo TKR in high-volume hospitals.
The risk for in-hospital mortality, and the complication rate following TKR, were significantly higher for blacks, Native Americans and mixed-race individuals.

In other words, minorities underwent fewer knee replacement procedures, but experienced a higher rate of complications and mortality for them.

Does this mean that knee replacement is inappropriate or ill-advised for nonwhites? Not necessarily; this is an observational study, not a controlled or randomized study, which means it is entirely possible that other socioethnic factors may be pushing the figures in one direction or another, independent of the medical facts.

Still it is a worthy reminder that medicine must take into account the whole patient, and that surgery is not always the first or best answer for knee pain.

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