JAAOS - 2026-07-01 - Journal Article; Randomized Controlled Trial
Functional Outcomes by Ethnicity and Sex Following Tumor Resection and Endoprosthetic Reconstruction: A Secondary Analysis of the Parity Trial.
Gonzalez MR, Goh MH, Werenski JO, Gebhardt MC, Ghert M, Lozano-Calderon SA, PARITY Investigators
Topics
Key Takeaway
Among 604 patients undergoing lower extremity endoprosthetic reconstruction, Asian patients had higher absolute MSTS-93 and TESS scores but similar delta scores to other ethnicities, while women achieved higher TESS MCID rates at all postoperative timepoints despite lower baseline function than men.
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Summary
This secondary analysis of the PARITY RCT examined whether ethnicity or sex influenced functional recovery (MSTS-93 and TESS) after lower extremity endoprosthetic reconstruction for bone tumors at 3, 6, and 12 months postoperatively. Asian patients had higher absolute preoperative and postoperative scores but similar delta scores to White, Black, and Hispanic patients; no ethnic minority group showed inferior outcomes to White patients. Women had lower baseline scores than men but demonstrated greater postoperative improvement (higher delta scores) and superior TESS MCID achievement rates at all timepoints.
Key Limitation
This is a secondary analysis of a trial designed to evaluate antibiotic prophylaxis, not functional equity; the study was not powered for subgroup comparisons by ethnicity, and the small minority subgroup sizes preclude definitive conclusions about Black and Hispanic patients specifically.
Original Abstract
BACKGROUND
Despite advances in limb-salvage surgery in orthopaedic oncology, the effect of ethnicity and sex on patient function recovery remains unclear. Our study examined the influence of sex and ethnicity on functional outcomes for patients with bone tumors undergoing lower extremity endoprosthetic reconstruction.
METHODS
This study was a secondary analysis of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial. Functional outcomes were assessed preoperatively and at 3, 6, and 12 months postoperatively using the Musculoskeletal Tumor Society 1993 (MSTS-93) and Toronto Extremity Salvage Score questionnaires. Delta scores (postoperative minus preoperative) and minimal clinically important difference thresholds were calculated by ethnicity and sex, and group differences were analyzed.
RESULTS
Among the 604 patients included, the main ethnic groups were White (63.6%), Asian (18.7%), Black (7.1%), Hispanic (5.6%), and Other (5%). Asian patients had markedly higher preoperative and postoperative MSTS-93 and TESS scores than other groups, although delta scores were similar across all ethnicities. Although MCID achievement rates for MSTS-93 did not differ by ethnicity, Asian patients showed a higher MCID achievement rate for TESS at 3 and 6 months. Sex-based analyses revealed that men had higher baseline functional scores, but women demonstrated greater postoperative improvements, as reflected by higher delta scores. Although postoperative MSTS-93 MCID achievement rates were similar between sexes, women exhibited higher TESS MCID achievement across all postoperative timepoints.
CONCLUSION
Asian patients had higher functional outcomes after endoprosthetic reconstruction, and ethnic minorities did not show worse outcomes than White patients. Additional research should explore these trends in different settings.
LEVEL OF EVIDENCE
I.