Article

The Frank Stinchfield Award The Impact of Socioeconomic Factors on Outcome After THA A Prospective, Randomized Study

Starkville Orthopedic Clinic, Starkville, MS, USA.
Clinical Orthopaedics and Related Research (Impact Factor: 2.88). 02/2011; 469(2):339-47. DOI: 10.1007/s11999-010-1519-x
Source: PubMed

ABSTRACT Background Most studies of total hip arthroplasty (THA) focus on the effect of the type of implant on the clinical result. Relatively little data are available on the impact of the patient's preoperative status and socioeconomic factors on the clinical results following THA. Questions/purposes We determined the relative importance of patient preoperative and socioeconomic status compared to implant and technique factors in predicting patient outcome as reflected by scores on commonly utilized rating scales (eg, Harris Hip Score, WOMAC, SF-12, degree of patient satisfaction, or presence or severity of thigh pain) following cementless THA. Methods All patients during the study period were offered enrollment in a prospective, randomized study to receive either a titanium, tapered, proximally coated stem; or a Co-Cr, cylindrical, extensively coated stem; 102 patients were enrolled. We collected detailed patient data preoperatively including diagnosis, age, gender, insurance status, medical comorbidities, tobacco and alcohol use, household income, educational level, and history of treatment for lumbar spine pathology. Clinical evaluation included Harris Hip Score, SF-12, WOMAC, pain drawing, and UCLA activity rating and satisfaction questionnaire. Implant factors included stem type, stem size, fit in the canal, and stem-bone stiffness ratios. Minimum 2 year followup was obtained in 95% of the enrolled patients (102 patients). Results Patient demographics and preoperative status were more important than implant factors in predicting the presence of thigh pain, dissatisfaction, and a low hip score. The most predictive factors were ethnicity, educational level, poverty level, income, and a low preoperative WOMAC score or preoperative SF-12 mental component score. No implant parameter correlated with outcome or satisfaction. Conclusion Socioeconomic factors and preoperative status have more impact on the clinical outcome of cementless THA than implant related factors.

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    • "There is conflicting evidence about the effect of socioeconomic status on outcomes following knee replacement with some studies reporting deprivation to be strongly associated with poorer postoperative outcomes [3] [5] [7] [8] while others report no association [9] [10] [11]. However, apart from one US study of hip replacement patients [12], previous studies failed to control for multiple implants, surgeons and different surgical techniques. Furthermore, there are no studies which report the influence of socioeconomic deprivation on postoperative outcomes following unicompartmental knee replacement. "
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