Effect of Socioeconomic Status on Outcomes After Hip Arthroscopy: Minimum 5-Year Follow-up

Abstract

Background:

The socioeconomic status (SES) of a patient has previously been shown to affect access to quality health care, as well as patient-reported outcomes (PROs) of certain medical treatments.

Purpose:

To evaluate the effect of social deprivation on PROs and the rate of secondary surgery at a minimum 5-year follow-up and compare this to the results seen in the 2-year study.

Study Design:

Case series; Level of evidence, 4.

Methods:

Demographic, intraoperative, and radiographic data were collected at the time of care and retrospectively analyzed for patients who underwent hip arthroscopy for the treatment of labral tear and femoroacetabular impingement between February 2008 and December 2017. Patients were included in the present analysis if they had a minimum 5-year follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), International Hip Outcome Tool–12 (iHOT-12) score, and visual analog scale (VAS) scores for both pain and satisfaction. Included patients were then divided into 4 cohorts based on their respective Social Deprivation Index (SDI), which was extrapolated from their zip code at the time of surgery. Rates of achieving the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) were calculated for the mHHS, NAHS, and VAS score, along with rates of revision surgery and conversion to total hip arthroplasty (THA), for comparison between the 4 cohorts.

Results:

A total of 452 hips (409 patients) were included. The mean follow-up for the entire study group was 83.0 ± 29.1 months. The division by SDI based on established quartiles yielded 135 patients in group 1, 130 patients in group 2, 96 patients in group 3, and 91 patients in group 4. Similar intraoperative findings, radiographic measurements, surgical procedures performed, and minimum 5-year PROs were observed between all 4 groups. There was a significant difference in the rate of revision ipsilateral hip arthroscopy and conversion to THA among all 4 groups, with group 4 having the highest rates of each. All groups achieved high rates of MCID for the mHHS, NAHS, and VAS score for pain, as well as high rates of PASS for the mHHS. A significant difference among patients in groups 1 to 4 achieving the PASS was reported for NAHS, with group 1 reporting the lowest rates of achievement.

Conclusion:

Regardless of SES, patients were able to achieve improvements in all PROs measured after hip arthroscopy for femoroacetabular impingement and labral tear. However, patients with a lower SES had higher rates of secondary surgeries, including revision hip arthroscopies and conversions to THA.