Racial Disparities in Above-knee Amputations After TKA: A National Database Study

Background

Above-knee amputation (AKA) is a rare but devastating complication of TKA. Although racial disparities have been previously reported in the utilization of TKA, it is unclear whether disparities exist in the rates of AKA after TKA.

Questions/purposes

(1) Which gender-racial group has the highest rate of AKA from septic and aseptic complications of TKA? (2) Which age groups have higher rates of AKA from septic and aseptic complications of TKA?

Methods

Using National Inpatient Sample data from 2000 to 2011, AKAs resulting from complications of TKA were identified using a combination of International Classification of Diseases, 9th Revision procedure and diagnosis codes. Of the 341,954 AKAs identified, 9733 AKAs were the result of complications of TKA (septic complications = 8104, aseptic complications = 1629). Standardized AKA rates were calculated for different age and gender- racial groups by dividing the number of AKAs in each group with the corresponding number of TKAs. Standardized rate ratios were calculated after adjusting for demographics and comorbidities.

Results

After adjusting for age and comorbidities, black men had the highest rate of AKA after TKA (adjusted rate in black men = 578 AKAs per 100,000 TKAs, standardized rate ratio [SRR] = 4.32 [confidence interval {CI}, 3.87–4.82], p < 0.001). Black men also had the highest rate of AKA after septic complications of TKA (p < 0.001). The adjusted rates of AKA were higher in patients younger than 50 years (adjusted rate = 473, SRR = 3.14 [CI, 2.94–3.36], p < 0.001) and older than 80 years (adjusted rate = 297, SRR = 1.85 [CI, 1.76–1.95], p < 0.001).

Conclusions

The rising demand for TKA has led to an increase in the number of AKAs performed for complications of TKA in the United States. Although we did not find an increase in the rate of AKA during the study period, certain populations, including black men and patients older than 80 years and younger than 50 years, had higher rates of AKA. Further studies are required to understand the reasons for these disparities and measures should be undertaken to eliminate these disparities.

Level of Evidence

Level III, therapeutic study.

     

Disparities in Solid Organ Transplantation for Ethnic Minorities: Facts and Solutions

The Diversity and Minority Affairs Committee of the American Society of Transplantation (AST) convened a symposium to examine organ transplantation in underserved and minority populations. The goals of the meeting included 'benchmarking' of solid organ transplantation among minority populations, review of the epidemiology of end-organ damage, exploration of barriers to transplantation services and development of approaches to eliminate disparities. Participants noted that minority populations were more likely to be adversely affected by limited preventive medical care, lack of counseling regarding transplant options, and delays in transplant referrals for organ transplantation. These features largely reflect economic disadvantage as well as the reduced presence of minority professionals with training in transplant-related specialties. Participants in the conference noted that recent changes in organ allocation policies had improved access to minority individuals once listed for renal transplantation. Similar advances will be needed for other organs to address inequities in pretransplant care and underrepresentation of minorities among transplant professionals. The biologic basis of differences in transplant outcomes for minority recipients has not been adequately studied. Research funds must be targeted to address biologic mechanisms underlying disparate transplant outcomes including the impacts of environment, education, poverty and lifestyle choices.     

髋关节离断术最早的记载

<正>刊载杂志:Trans.Kentucky.Med.Soc.265-266,1852.最早的髋关节离断术应该是Dr.Walter Brashear于1806年开展的。患者为17岁的混血少年,股骨骨折合并严重的软组织损伤,手术分两个阶段施行,术后完全康复并且一直存活着。当时为那个患者实施的髋关节离断术,用现在医学发展水平来评价,可能有些欠妥当。然而,在40多年前无任何资料参考,仅凭自己的知识和技术能力开展这样的手术,使得患者得到了成功救治,应该是值得赞赏的。     

Minimizing Disparities in Osteoporosis Care of Minorities With an Electronic Medical Record Care Plan

Background  

Ethnic disparities in care have been documented with a number of musculoskeletal disorders including osteoporosis. We suggest a systems approach for ensuring osteoporosis care can minimize potential ethnic disparities in care.     

Through-Knee Amputations

The operative technique of through-knee amputations is described. In a retrospective series of 71 patients re-amputation at the above-knee level was performed in 18 per cent of the cases. Prosthetic gait was achieved in 97 per cent of patients discharged to their own home with preserved level of amputation.

Through-knee amputation is preferable to amputation above the knee and should even be considered as an alternative to below-knee amputation in patients with borderline skin perfusion blood pressure and in feeble patients with poor balance.     

Through-Knee Amputations

The operative technique of through-knee amputations is described. In a retrospective series of 71 patients re-amputation at the above-knee level was performed in 18 per cent of the cases. Prosthetic gait was achieved in 97 per cent of patients discharged to their own home with preserved level of amputation.

Through-knee amputation is preferable to amputation above the knee and should even be considered as an alternative to below-knee amputation in patients with borderline skin perfusion blood pressure and in feeble patients with poor balance.