Patients Undergoing Hip Arthroscopy for Acetabular Labral Treatment From Neighborhoods With Greater Socioeconomic Disadvantage Experience Worse Health Care Accessibility, Inferior Midterm Functional Outcomes, and Similar Rates of Conversion to Total Hip Arthroplasty.

Abstract

To investigate the effects of neighborhood-level socioeconomic disadvantage on health care accessibility and midterm functional outcomes for patients undergoing primary hip arthroscopy for the treatment of acetabular labral tears. This retrospective analysis queried patients ≥18 years old who underwent primary hip arthroscopy for treatment of symptomatic labral tears secondary to femoroacetabular impingement syndrome, had complete patient-reported outcome measures (PROMs) at minimum 8-year follow-up, and resided in the United States. All patients underwent surgery between May 2001 and September 2013. Using the area deprivation index (ADI) to quantify neighborhood-level socioeconomic disadvantage, patients were divided into quartiles. Those in the least and most disadvantaged quartiles represented the ADI_Low and ADI_High cohorts, respectively. Health care accessibility and socioeconomic disadvantage were compared between cohorts using rural, Health Professional Shortage Area, medically underserved area/population, insurance status, education level, and household income classifications. Collected PROMs included the modified Harris Hip Score (mHHS), Hip Outcome Score (HOS)-Activities of Daily Living (HOS-ADL), HOS-Sports Specific Subscale (HOS-SSS), Nonarthritic Hip Score, 33-item International Hip Outcome Tool, and rates of conversion to total hip arthroplasty (THA). The ADI_Low (ADI: 4.0 ± 2.1) and ADI_High (ADI: 37.7 ± 12.1) cohorts each consisted of 43 patients. A greater proportion of patients in ADI_High resided in rural communities (P = .026), primary care Health Professional Shortage Areas (P = .024), and medically underserved area/populations (P = .019). At a patient level, the ADI_High cohort had lower levels of insurance coverage (P = .035), education (P = .002), and household income (P = .002). Finally, ADI_High patients achieved worse functional outcome scores for mHHS (P = .008), Nonarthritic Hip Score (P = .043), HOS-ADL (P = .020), and 33-item International Hip Outcome Tool (P = .041). By multivariate logistic regression, patients in ADI_High were nearly 11.4 and 10.4 times less likely to achieve the 10-year patient acceptable symptom state for mHHS (odds ratio, 0.09; P = .008) and HOS-ADL (odds ratio, 0.10; P = .018), respectively. Despite having significantly worse PROMs, patients in ADI_High underwent statistically similar rates of revision hip arthroscopy (ADI_High: 7.0% vs. ADI_Low: 4.7%; P = .645) and conversion to THA (ADI_High: 11.6% vs ADI_Low: 20.9%; P = .213). Patients undergoing hip arthroscopy for acetabular labral treatment from neighborhoods with greater ADI scores experience worse health care accessibility, inferior mid-term functional outcomes, and similar rates of conversion to THA. Level III, retrospective cohort.