Summary

Although hip arthroscopy patients experiencing greater neighborhood-level socioeconomic disadvantage exhibited significantly lower preoperative baseline scores, this disparity resolved at 1-year follow-up.

Abstract

PURPOSE/HYPOTHESIS: The purpose of the present study is to investigate the influence of neighborhood-level socioeconomic status (SES) on functional outcomes following hip arthroscopy. We hypothesize that patients experiencing greater neighborhood-level socioeconomic disadvantage would report worse pre-operative baseline PROM scores and post-operative outcomes.

Methods

This retrospective analysis of prospectively collected data queried patients aged greater than 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 ADILow and ADIHigh 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 ADILow (n = 113; ADI: 5.8 ± 3.0; range: 1 to 12) and ADIHigh (n=115; ADI: 28.0 ± 14.5; range: 13 to 97) cohorts had no differences in baseline patient demographics. When comparing mean pre-operative baseline PROM scores between groups, a lower ADI score (ADILow) was associated with significantly higher scores compared to ADIHigh for all 5 PROMs: mHHS (66.3 ± 13.1 vs 61.8 ± 14.9; P = 0.017), HOS-ADL (74.5 ± 17.7 vs 67.6 ± 18.7; P = 0.005), HOS-SSS (47.8 ± 24.1 vs 41.1 ± 23.7; P = 0.034), NAHS (68.2 ± 16.8 vs 63.0 ± 17.3; P = 0.023), and iHOT-33 (43.8 ± 16.9 vs 38.6 ± 17.4; P = 0.024). At 1-year follow-up, these disparities resolved with both groups reporting statistically similar functional outcomes for all PROMs (P > 0.05). Furthermore, patients in both cohorts achieved similar rates of MCID for all 5 PROMs and PASS for 4 PROMs. When controlling for patient demographics, however, 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.