Rehabilitation After Total Knee Arthroplasty: Do Racial Disparities Exist?

J Arthroplasty. 2020 Mar;35(3):683-689. doi: 10.1016/j.arth.2019.10.048. Epub 2019 Nov 2.


Background: Racial disparities in functional outcomes after total knee arthroplasty (TKA) exist. Whether differences in rehabilitation utilization contribute to these disparities remains to be investigated.

Methods: Among 8349 women enrolled in the prospective Women's Health Initiative cohort who underwent primary TKA between 2006 and 2013, rehabilitation utilization was determined through linked Medicare claims data. Postacute discharge destination (home, skilled nursing facility, and inpatient rehabilitation facility), facility length of stay, and number of home health physical therapy (HHPT) and outpatient physical therapy (OPPT) sessions were compared between racial groups.

Results: Non-Hispanic black women had worse physical function (median score, 65 vs 70) and higher likelihood of disability (13.2% vs 6.9%) than non-Hispanic white women before surgery. After TKA, black women were more likely to be discharged postacutely to an institutional facility (64.3% vs 54.5%) than white women, were more likely to receive HHPT services (52.6% vs 47.8%), and received more HHPT and OPPT sessions. After stratification by postacute discharge setting, the likelihood of receipt of HHPT or OPPT services was similar between racial groups. No significant difference in receipt of HHPT or OPPT services was found after use of propensity score weighting to balance health and medical characteristics indicating severity of need for physical therapy services.

Conclusion: Rehabilitation utilization was generally comparable between black and white women who received TKA when accounting for need. There was no evidence of underutilization of post-TKA rehabilitation services, and thus disparities in post-TKA functional outcomes do not appear to be a result of inequitable receipt of rehabilitation care.

Keywords: African American; discharge destination; disparity; joint replacement; knee replacement; physical therapy.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Knee*
  • Black People
  • Female
  • Healthcare Disparities*
  • Humans
  • Medicare
  • Patient Discharge
  • Prospective Studies
  • Skilled Nursing Facilities
  • United States
  • White People