Rehabilitation after Total Knee Arthroplasty: Do Racial Disparities Exist?

Abstract Background Racial disparities in functional outcomes after TKA exist. Whether differences in rehabilitation utilization contribute to these disparities remains to be investigated. Methods Among 8,349 women enrolled in the prospective Women’s Health Initiative cohort who underwent primary TKA between 2006-2013, rehabilitation utilization was determined through linked Medicare claims data. Post-acute discharge destination (home, skilled nursing facility, inpatient rehabilitation facility), facility length of stay, and number of home health and outpatient physical therapy (PT) 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 prior to surgery. After TKA, Black women were more likely to be discharged post-acutely to an institutional facility (64.3% vs. 54.5%) than White women, were more likely to receive home health PT services (52.6% vs. 47.8%), and received more home health and outpatient PT sessions. After stratification by post-acute discharge setting, the likelihood of receipt of home or outpatient PT services was similar between racial groups. No significant difference in receipt of home or outpatient PT services was found after use of propensity score weighting to balance health and medical characteristics indicating severity of need for PT 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.