Neighborhood Deprivation and Association With Implant Complications Following Total Joint Arthroplasty: A Nationwide Analysis.

Abstract

Comprised of 17 census-based markers, the Area Deprivation Index (ADI) is a weighted index of material deprivation within neighborhoods, defined as the lack of basic resources and services. The literature lacks studies on associations of neighborhood deprivation, or aggregate socioeconomic status within neighborhoods, with implant survivorship. The purpose of our study was to assess whether patients who have high ADIs (greater disadvantage) undergoing primary total joint arthroplasties were associated with differences in implant-related complications. A retrospective query of primary total joint arthroplasties (total knee arthroplasties [TKAs] and total hip arthroplasties [THAs]) was performed using an insurance claims database from 2010 through 2021. The ADI is reported on a scale of 0 to 100, with higher numbers associated with greater disadvantage. Patients who had high ADI (≥ 90) were 1:1 propensity-score matched to a low ADI (<90) comparison group by age, sex, and Elixhauser Comorbidity Index. This yielded 625,232 patients (TKAs = 385,794, THAs = 239,438). Primary end points compared 2-year implant-related complications, including periprosthetic joint infections (PJIs), periprosthetic fractures, dislocations, aseptic loosenings, and revisions. Multivariable logistic regressions computed the odds ratios (ORs) of ADI on 2-year implant complications. P-values less than 0.001 were significant. Patients undergoing TKAs from high ADIs experienced similar incidence and odds of any implant-related complications (5.1 versus 5.0%; OR: 1.01, P = 0.53), including PJIs (1.8 versus 1.7%; OR: 1.05, P = 0.031), periprosthetic fractures (0.2 versus 0.2%; OR: 0.96, P = 0.62), dislocations (0.3 versus 0.3%; OR: 1.03, P = 0.62), aseptic loosenings (0.7 versus 0.7%; OR: 1.00, P = 0.95), or revisions (2.1 versus 2.1%; OR: 0.99, P = 0.99). Patients undergoing THAs from high ADIs experienced a greater incidence and odds of developing any implant-related complications (6.6 versus 6.2%; OR: 1.07, P = 0.0004), including PJIs (1.8 versus 1.6%; OR: 1.14, P < 0.0001). Socioeconomically disadvantaged patients experienced similar 2-year implant-related complications following TKA; however, slight, though likely not clinically significant, differences were found following THA. III.