Intersectional racial, ethnic, and sex-based disparities in length of stay after total hip and knee arthroplasty: An analysis of national data.
Abstract
OBJECTIVE
To identify the presence and magnitude of total joint arthroplasty (TJA) disparities in length of stay (LOS).
METHODS
The National Inpatient Sample (2016-2019) was queried for patients with primary diagnoses of osteoarthritis (OA) and primary procedure code of primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). Race and ethnicity and sex variables were recoded and combined into 12 categories. We determined the effect of this combined race and sex variable on extended length of stay, controlling for potential intermediates and demographic variables, and conducted analysis of individual heterogeneity and discriminatory accuracy (AIHDA) analyses.
RESULTS
A total of 1507,085 THAs and 2534,749 TKAs were captured during the study period. White females constituted the greatest proportion of THAs and TKAs. Nearly all minoritized race/ethnicities, regardless of sex, were at greater risk of extended length of stay (eLOS, > 3 days) compared to White males. Black females experienced the greatest disparity of eLOS [THA, aOR 2.42 (95% CI: 2.26-2.60, p<0.001); TKA, aOR 2.07 (95% CI: 1.96-2.18, p<0.001)] followed by Black males [THA, aOR 1.86 (95% CI: 1.72-2.02, p<0.001); TKA, aOR 1.89 (95% CI: 1.77-2.02, p<0.001)]. AIHDA analysis showed that race/ethnicity and sex did not significantly improve discriminatory accuracy when included in the models.
CONCLUSION
There are significant racial and ethnic disparities in THA/TKA hospital LOS which are both statistically and clinically significant. Social determinants of health (SDOH) continue to play a meaningful role in these outcomes, though targeting race/ethnicity and sex directly may not improve eLOS in patients.
Links & Identifiers
10.1016/j.joca.2025.10.016 Open → 41175923 View on PubMed → MeSH Terms
Keywords
Citation
Rumalla KC, Chandrupatla SR, Singh JA. Intersectional racial, ethnic, and sex-based disparities in length of stay after total hip and knee arthroplasty: An analysis of national data.. Osteoarthritis and cartilage. 2026;34(1):160-166. doi: 10.1016/j.joca.2025.10.016
BibTeX
@article{kc2026intersectionalracialethnic,
title = {Intersectional racial, ethnic, and sex-based disparities in length of stay after total hip and knee arthroplasty: An analysis of national data.},
author = {Rumalla KC and Chandrupatla SR and Singh JA},
journal = {Osteoarthritis and cartilage},
year = {2026},
volume = {34},
number = {1},
pages = {160-166},
doi = {10.1016/j.joca.2025.10.016},
pmid = {41175923},
url = {https://doi.org/10.1016/j.joca.2025.10.016}
}