Socioeconomic disparities in the utilisation of metal-on-metal hip resurfacing compared to uncemented total hip arthroplasty: a population-based case-control study in Sweden.

Abstract

This study aimed to compare preoperative education level, income level, and geographical birthplace between patients undergoing metal-on-metal hip resurfacing (MoM-HR) and those receiving a conventional uncemented total hip arthroplasty (THA). All patients with osteoarthritis who underwent a MoM-HR or an uncemented THA registered in the Swedish Arthroplasty Register 1999-2014 were included (<i>n</i> = 15,871). National databases provided additional information on household income and the highest achieved education. 1481 MoM-HR patients were matched to 1481 uncemented THA patients based on age, sex, and Charlson comorbidity index. Odds ratios (OR) of MoM-HR surgery depending on socioeconomic variables were calculated using logistic regression analysis. The OR of having MoM-HR surgery was lower among patients with lower education level compared to those with a university degree. Also, 37% of the MoM-HR patients had an income in the 2 highest quintiles compared to 32% of uncemented THA patients. There was no difference in accessibility of MoM-HR surgery between patients born in or outside Sweden. In Sweden, within a universal healthcare coverage system, lower socioeconomic status in terms of education level was associated with decreased accessibility to innovative hip surgery, i.e., MoM-HR.