JOA - 2026-09-07 - Journal Article
Trends in Racial and Socioeconomic Differences in Cementless Total Knee Arthroplasty Utilization Among Medicare Beneficiaries from 2016 to 2022.
Ricca GW, Torres RB, Wong L, Van Hyfte G, Dhanjani SA, Shatkin MS, Hayden BL, Moucha CS, Chen DD
Topics
Key Takeaway
Cementless TKA utilization grew from 2.4% to 9.9% (CAGR 26.7%) among Medicare beneficiaries 2016–2022, but Hispanic dual-eligible patients had 14% lower adjusted odds (OR 0.86) of receiving cementless fixation versus White non-dual-eligible patients.
Summary Depth
Choose how much analysis to show on this article page.
Summary
Using Medicare fee-for-service claims 2016–2022, this study examined whether race and dual Medicare-Medicaid eligibility (SES proxy) predicted cementless versus cemented TKA utilization across 1,044,345 primary elective inpatient TKAs. Cementless fixation grew from 2.4% to 9.9% overall, but multivariable logistic regression showed Black dual-eligible (OR 0.92), Hispanic dual-eligible (OR 0.86), and Hispanic non-dual-eligible (OR 0.84) patients had significantly lower odds of cementless fixation versus White non-dual-eligible patients. Notably, Black non-dual-eligible patients had slightly higher odds (OR 1.05), indicating the disparity pattern is not uniform across minority groups.
Key Limitation
Dual Medicare-Medicaid eligibility is a coarse SES proxy that cannot capture income gradients, education, health literacy, or patient preference, leaving the mechanism driving utilization differences—whether surgeon bias, patient refusal, implant cost allocation, or hospital formulary restrictions—entirely unresolved.
Original Abstract
BACKGROUND
Cementless total knee arthroplasty (TKA) has reemerged with advances in implant design promoting improved durability. However, differences in the utilization of emerging orthopaedic technologies persist, and the influence of race and socioeconomic status on cementless fixation adoption remains unclear. This study evaluated national trends in cementless TKA utilization across race and socioeconomic status.
METHODS
Medicare fee-for-service claims (2016 to 2022) were used to identify adult patients who underwent primary, elective, inpatient TKA via International Classification of Diseases, Tenth Revision, Procedure Coding System codes. Patients were grouped by race (White, Black, or Hispanic) and dual Medicare-Medicaid eligibility (yes/no) as a proxy for socioeconomic status. Procedures were categorized as cementless or cemented fixation. Cochran-Armitage trend tests and compound annual growth rate (CAGR) were used to evaluate annual trends. Multivariable logistic regression models examined the association between race-socioeconomic subgroups and cementless fixation, adjusting for demographic, clinical, and hospital factors.
RESULTS
Among 1,044,345 TKAs, 4.8% (50,141) were cementless, increasing from 2.4% in 2016 to 9.9% in 2022 (CAGR 26.7%; P < 0.0001). The CAGR for cementless TKA was highest for Hispanic non-dual-eligible (CAGR 30.6%) and White non-dual-eligible (CAGR 27.3%) patients and lowest among Hispanic dual-eligible patients (CAGR 16.9%). After multivariable adjustment, Black dual-eligible (odds ratio (OR) 0.92; P = 0.015), Hispanic dual-eligible (OR 0.86; P = 0.004), and Hispanic non-dual-eligible (OR 0.84; P = 0.030) patients had significantly lower odds of receiving cementless fixation versus White non-dual-eligible counterparts. Black non-dual-eligible patients demonstrated higher odds (OR 1.05; P = 0.041). Although several differences reached statistical significance, the magnitude of adjusted odds ratios was modest.
CONCLUSION
Cementless TKA grew across all race-socioeconomic categories among Medicare beneficiaries. However, most minority and lower-income subgroups were less likely to receive this reemerging technique, with differences concentrated among Hispanic and dual-eligible patients. These findings highlight variation in adoption of emerging orthopaedic technologies across patient populations.