Clinical Edge

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Education Allays Poverty’s Effect on TKA Outcomes

Arthritis Care Res; ePub 2017 Nov 22; Goodman, et al

In poor communities, those without college attain 2-year Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores following total knee arthroplasty (TKA) that are 10 points worse than those with some college, a recent study found. Education, however, has no impact on TKA outcomes in wealthy communities. Patient level variables from an institutional registry were linked to US Census Bureau data. Researchers found:

  • Of 3,970 TKA patients, 2,438 (61%) had some college or more.
  • Having no college was associated with worse pain and function at baseline and 2 years.
  • Living in a poor neighborhood (>20% below poverty) was associated with worse 2-year pain and function.
  • There was a strong interaction between individual education and community poverty with WOMAC scores at 2 years.
  • Patients without college living in poor communities had pain scores that were ~10 points worse than those with some college (83.4% vs 75.7%); in wealthy communities, college was associated with a 1-point difference in pain (function was similar).


Goodman SM, Mandl LA, Mehta B, et al. Education mitigates the effect of poverty on total knee arthroplasty outcomes. [Published online ahead of print November 22, 2107]. Arthritis Care Res. doi:10.1002/acr.23442.

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