Introduction

Disparities in access and outcomes of total hip replacement care persist, particularly among racial minorities and socioeconomically disadvantaged groups. Patient-reported outcome measures (PROMs) have come to be understood as a valuable tool in assessing quality of care in medicine.^1,2,3 The Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR) is a validated PROM survey to assess function and pain for patients undergoing total hip arthroplasty. Our goal is to examine whether certain patient demographics are associated with preoperative and postoperative HOOS scores.

Methods

This is a retrospective study of 3,307 THAs at a single academic institution from 2015-2023. Multivariate regression analyses were performed to determine the effects of race, sex, marital status, age, and insurance type on length of stay, discharge disposition, preop HOOS, 6-week postop HOOS, 1-year postop HOOS, and changes in HOOS score over time. We controlled for confounders of body mass index, Elixhauser comorbidity index, and surgical approach.

Results

Longer hospital stay was associated with older age, unmarried status, black race, and female sex (p<0.05). Discharge to a rehab facility was associated with older age, government payer, unmarried status, and female sex (p<0.05). Lower preoperative HOOS scores were associated with younger age, government payer, unmarried status, black race, and female sex (p<0.05). Lower 6-week postoperative HOOS scores were associated with younger age (p=0.04) and black race (p<0.01). Lower 1-year postoperative HOOS scores were associated with black race (p=0.03) and female sex (p=0.03). A decreased improvement from preoperative to 6-week HOOS scores was associated with older age, private payers, unmarried status, and male sex (p<0.05). A decreased improvement from preoperative to 1-year HOOS scores was associated only with older age (p<0.001).

Conclusions

Social determinants of health, such as marital status, age, and sex, are associated with length of stay and discharge disposition. While black race was consistently associated with lower absolute HOOS scores at all time-points, the change in HOOS scores did not differ by race, implying a similar amount of improvement from preoperative function. Further research is warranted into why black patients present with lower HOOS scores preoperatively and how to address disparities in HOOS improvement.

References

1. Osteoarthritis (OA). www.cdc.gov/arthritis/basics/osteoarthritis

2. Amen TB, Varady NH, Rajaee S, Chen AF. Persistent Racial Disparities in Utilization Rates and Perioperative Metrics in Total Joint Arthroplasty in the U.S.: A Comprehensive Analysis of Trends from 2006 to 2015. J Bone Jt Surg. 2020;102(9):811-820.

3. Cohen-Levy WB, Lans J, Salimy MS, Melnic CM, Bedair HS. The Significance of Race/Ethnicity and Income in Predicting Preoperative Patient-Reported Outcome Measures in Primary Total Joint Arthroplasty. J Arthroplasty. 2022;37(7):S428-S433.