No meaningful clinical differences in patient reported outcome scores for Native Hawaiian/Pacific Islanders following knee or hip arthroplasty.

Abstract

Background: Most studies investigating the influence of race on patient reported outcomes (PROs) compare Black and/or Hispanic patients to White patients. Few have examined differences in PROs between Native Hawaiian/Pacific Islander (NHPI), Asian, and White patients, which comprise most of the population of Hawai'i. The purpose of this study was to examine differences in perioperative PROs between NHPI, Asian, and White patients and discuss observed outcome disparities if present.

Methods: A retrospective evaluation of Asian, White and NHPI patients undergoing elective, unilateral total hip (THA) or total knee arthroplasty (TKA) between April 2019 and April 2023 was performed. Patient demographics, Charlson Comorbidity Index (CCI), Patient-Reported Outcomes Measurement Information System (PROMIS) global physical health (GPH) and global mental health (GMH), patient satisfaction, and Hip/Knee Disability and Osteoarthritis Outcome Score for Joint replacement (H/KOOS JR) were collected. Analysis of variance and chi-square tests were performed to detect differences between racial groups.

Results: NHPI patients had the highest average body mass index (BMI, kg/m²) and the largest proportion of patients classified as obese for both surgical groups. NHPI patients also reported the lowest preoperative H/KOOS JR, PROMIS GPH, and PROMIS GMH scores compared to Asian and White patients. However, by 1 year post surgery, there were no significant differences in H/KOOS JR and PROMIS GPH amongst NHPI, Asian and White patients. PROMIS GMH was not significantly different for TKA patients at 1 year post surgery, but was significantly different for THA patients, with NHPIs reporting the lowest scores.

Conclusion: NHPI patients undergoing TKA and THA reported poorer preoperative scores but achieved similar outcomes as Asian and White patients following surgery. Lower preoperative scores may be due to higher levels of obesity in NHPI patients, but these factors do not seem to be predictive of poorer outcomes.