Does ethnicity and education influence preoperative disability and expectations in patients undergoing total knee arthroplasty?

Aim: To investigate whether minority ethnicity and the duration of education influence preoperative disability and expectations in patients undergoing total knee arthroplasty.

Methods: We prospectively included 829 patients undergoing primary unilateral total knee arthroplasty (TKA) from April 2013 to December 2014 at a single centre. Patients filled in pre-operative questionnaires with information regarding place of birth, duration of education, expectations for outcome of surgery and baseline characteristics. Patients were stratified based on ethnicity. Majority ethnicity was defined as born in the study country and minority ethnicity was defined as born in any other country. Similarly, patients were stratified based on duration of education in groups defined as < 9 years, 9-12 years and > 12 years, respectively.

Results: We found that 92.2% of patients were of majority ethnicity. We found that 24.5%, 44.8% and 30.8% of patients had an education of < 9 years, 9-12 years and > 12 years, respectively. The mean preoperative (pre-OP) oxford knee score (OKS) in the total population was 23.6. Patients of minority ethnicity had lower mean pre-OP OKS (18.6 23.9, < 0.001), higher pain levels (VAS 73.0 58.7, < 0.001), expected higher levels of post-OP pain (VAS 14.1 6.1, = 0.02) and of overall symptoms (VAS 16.6 6.4, = 0.006). Patients with > 12 years education had lower mean pre-OP OKS (21.5 23.8 and 24.6, < 0.001) and higher pre-OP VAS pain (65.4 59.2 and 56.4, < 0.001) compared to groups with shorter education. One year post-operative (post-OP) patients of minority ethnicity had lower mean OKS, higher pain and lower QoL. One year post-OP patients with > 12 years education reported higher pain compared to patients with shorter educations. However, the response-rate was low (44.6%), and therefore post-OP results were not considered to be significant.

Conclusion: Minority ethnicity and the duration of education influence preoperative disability and expectation in patients undergoing TKA. This should be taken into account when patients are advised pre-operatively.