Hip Arthroscopy Patients Experiencing Greater Neighborhood-Level Socioeconomic Disadvantage are More Likely to Achieve Minimal Clinically Important Differences in Functional Outcomes at 1-Year Follow-up

Abstract

Objectives:

The purpose of the present study is to investigate the influence of neighborhood-level socioeconomic status (SES) on functional outcomes following hip arthroscopy.

Methods:

This retrospective analysis of prospectively collected data queried patients aged ≥18 years with minimum 1-year follow-up who underwent hip arthroscopy for the treatment of symptomatic labral tears secondary to FAI. The study population was divided into ADI_Low and ADI_High cohorts according to ADI score, a validated measurement of neighborhood-level SES standardized to yield a score between 1 and 100. Collected patient-reported outcomes measures (PROMs) included the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score (HOS)–Activities of Daily Living (HOS-ADL), HOS–Sports Specific Subscale (HOS-SSS), 33-item International Hip Outcome Tool (iHOT-33), VAS pain score, and patient satisfaction.

Results:

228 patients met inclusion criteria and were included in the final analysis. After stratifying patients by ADI score, the ADI_Low (n = 113; mean ADI: 5.8 ± 3.0; range: 1 to 12) and ADI_High (n=115; mean ADI: 28.0 ± 14.5; range: 13 to 97) cohorts had no differences in baseline patient demographics. ADI_High patients reported significantly worse pre-operative baseline scores for all 5 PROMs; however, these differences were not present by 1-year follow-up. Furthermore, patients in both cohorts achieved similar rates of MCID for all 5 PROMs and PASS for 4 PROMs. When controlling for patient demographics, patients with higher ADI scores had greater odds of achieving MCID for all PROMs except for iHOT-33.

Conclusions:

Although hip arthroscopy patients experiencing greater neighborhood-level socioeconomic disadvantage exhibited significantly lower preoperative baseline scores, this disparity resolved at 1-year follow-up. In fact, when adjusting for patient characteristics including ADI score, more disadvantaged patients achieved greater odds of achieving MCID. The present study is merely a first step towards understanding health inequities among patients seeking orthopaedic care. Further development of clinical guidelines and health policy research are necessary to advance care for patients from disadvantaged communities.