Health Disparities in Aseptic Revision Total Hip Arthroplasty: Assessing the Impact of Social Determinants of Health.

Abstract

Social determinants of health (SDOH) have been shown to reliably predict outcomes in patients undergoing orthopaedic procedures. However, there remains a paucity of data in the literature on whether SDOH can predict adverse outcomes in those undergoing aseptic revision total hip arthroplasty (rTHA). We aimed to examine the relationship between SDOH and clinical outcomes in aseptic rTHA. This retrospective study identified 843 patients undergoing aseptic rTHA using an institutional joint registry. Data on demographics, length of stay, 90-day complications, discharge disposition, and re-revisions were recorded. The Area Deprivation Index (ADI) and four subscales of the Social Vulnerability Index (SVI) were identified using census tract codes. High vulnerability to SDOH was defined as the top quartile for ADI and each SVI category. A multivariate regression was performed to identify risk factors for worse clinical outcomes. Patients who had a higher ADI (43.2 versus 22.6%, P < 0.001) and SVI (32.9 versus 22.9%, P = 0.011) were revised for aseptic loosening at a higher proportion compared to their counterparts. Additionally, a lower prevalence of osteolysis was observed in patients who had a high ADI compared to those who had a low ADI (3.7 versus 10.6%, P = 0.048). In multivariate analyses, a high overall SVI was an independent risk factor for mortality (odds ratio [OR] = 2.40, P = 0.020). A higher household SVI was associated with increased mortality (OR = 2.13, P = 0.038) and reoperations (OR = 1.89, P = 0.039). Similarly, patients who had high housing and transportation SVI had higher odds of 90-day complications (OR = 1.66, P = 0.045) and PJI episodes (OR = 2.33, P = 0.028). Patients who had higher levels of deprivation exhibited different surgical indications and poorer clinical outcomes following aseptic rTHA. Our findings suggest that SVI is an effective tool for assessing SDOH.