Abstract
Objectives:
Social deprivation has been shown to play a key role in affecting postoperative outcomes in orthopedic literature, with many studies suggesting that greater degrees of social deprivation are linked with poorer outcomes. Different measures of social inequality have been used, specifically measures such as the social deprivation index (SDI), which takes into account common factors of social scarcity within a certain area (i.e. % of those under poverty line, unemployed, high school level of education, etc). Prior studies comparing patients with different degrees of SDI on outcomes after hip arthroscopy have shown similar outcomes between groups. However, long-term outcomes have yet to be described. Thus, the goal of this study is to determine differences in 10-year patient-reported-outcomes (PRO), clinically-significant-outcomes (CSOs, and survivorship between patients with low SDI scores and high SDI scores after hip arthroscopy.
Methods:
A retrospective review was conducted of patients who underwent primary hip arthroscopy for FAIS from January 2012 through June 2014 with minimum 10 year follow up. SDI values were determined by patient zip code at time of surgery. The average national SDI between 2011 and 2015 was obtained and quartile cutoffs below 25% and above 75% were determined. Patients were separated into these two groups based on whether they fell into the low <25% SDI quartile or in the high >75% SDI quartile. Those in the higher SDI quartile are thought to experience greater social deprivation compared those in the low SDI quartile. Patient demographics were compared between groups. Preoperative and postoperative radiographs were assessed. Patient-reported outcomes (PROs) were collected at preoperative, 2, 5, and 10 year follow up, and achievement rates of Minimal Clinically Important Difference (MCID) and Patient-Acceptable Symptom State (PASS) were calculated. PRO measures included the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales, modified Harris Hip Score (mHHS), 12-item international Hip Outcome Tool (iHOT-12), and Visual Analog Scales (VAS) for Pain and Satisfaction. PROs, MCID and PASS achievement rates, and survivorship were compared between groups.
Results:
One hundred fifty-two patients with bottom quartile SDIs (64.4% female; age: 32.7 ± 13.3 years, BMI: 22.2 ± 2.8 kg/m2) were compared to seventy patients with upper quartile SDIs (58.6% female; age: 36.6 ± 10.6 years, BMI: 25.2 ± 4.4 kg/m2). Differences in age (low SDI: 32.7 vs. high SDI: 36.6 p = 0.020) and ethnicity (low SDI: 94.1% white vs. high SDI: 77.1% white, p = 0.001) were significant. Postoperatively, patients in the low SDI group had significantly lower alpha angles on Dunn lateral view compared to patients in the high SDI group. (38.0 ± 3.7 vs 39.6 ± 5.4, p = 0.036). Otherwise, there were no significant differences between groups in any other demographic characteristic, radiographic measurement, or intraoperative finding (p ≥ 0.099). Both groups demonstrated significant improvement in all PROs between the preoperative and 10-year postoperative time points (p < 0.001 for all).
Preoperatively, patients with higher SDIs had significantly lower HOS-ADL and mHHS scores (p < 0.034). At 2 years, patients with higher SDI scores had significantly higher VAS Pain scores compared to the less socially deprived (p = 0.028). For all other measures at 2, 5 and 10-year follow up, both mean PROs and the magnitude of change (delta) in PRO scores between preoperative to final 10 year follow up were similar between groups (p ≥ 0.058). The rates of MCID and PASS achievement at 10 years were also similar between groups. (p ≥ 0.052 for all). There was no difference in reoperation rate between groups, with 4.6% of the low SDI group and 7.1% of the high SDI group undergoing revision hip arthroscopy (p = 0.525), and 7.9% of the low SDI group and 2.9% of the high SDI group undergoing conversion to total hip arthroplasty (p = 0.235)
Conclusions:
Patients with higher levels of social deprivation characterized by the social deprivation index undergoing primary hip arthroscopy for FAIS demonstrated worse outcomes preoperatively, and up to 2 years, but similar clinical outcomes and hip survivorship at 10-year follow-up compared to patients with lower levels of social deprivation.
