Disparities in Revision Arthroplasty: A Scoping Review of Racial, Sex-Based, and Geographic Domains.

Abstract

PURPOSE OF REVIEW: Revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) are high-cost procedures that disproportionately burden patients and healthcare systems. While disparities in primary total joint arthroplasty (TJA) are well documented, inequities specific to revision TJA remain less clearly characterized and are inconsistently interpreted. This scoping review synthesizes studies published from January 2019 onward to examine racial, sex-based, and geographic disparities in revision total hip or knee arthroplasty. RECENT FINDINGS: Twenty-six studies met the inclusion criteria. Racial disparities were the most consistently documented, with multiple large database and registry studies demonstrating higher aseptic revision risk following primary TKA among Black patients compared with White patients. These disparities persisted after adjusting for patient, surgeon, and hospital characteristics. In contrast, racial disparities in revision THA were less consistent. Sex-based differences in revision TJA were smaller in magnitude and more heterogeneous, often reflecting biologic and biomechanical variation rather than access-related inequities. Geographic disparities highlighted substantial regional variation in revision TJA utilization and the influence of community-level social determinants of health on revision TJA risk and access. Disparities in revision TJA are multifactorial and reflect the interaction of differential revision TJA risk, unequal access to revision TJA care, and cumulative exposure to social determinants of health across the arthroplasty care continuum. Advancing revision TJA equity will require integrating measures of revision TJA risk and revision TJA access, incorporating social vulnerability into risk stratification, and designing policy interventions that address structural determinants of surgical care.