Is Neighborhood Socioeconomic Deprivation Associated With Outcomes Following Primary THA and TKA? A Systematic Review Utilizing the Area Deprivation Index.
Angelina R Furyes, Khaled A Elmenawi, Loren Hackett et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review examined whether neighborhood deprivation measured by the Area Deprivation Index (ADI) was associated with outcomes after primary total hip or knee arthroplasty. Sixteen studies were included; findings were synthesized qualitatively because of study heterogeneity. Higher ADI was consistently associated with greater healthcare utilization, including longer hospital stays, nonhome discharge, and emergency department visits, as well as more medical complications. Patients in more deprived neighborhoods had worse absolute postoperative patient-reported scores, although improvement was comparable and all groups achieved the minimum clinically important difference. Evidence on implant survivorship was limited but suggested poorer outcomes with greater deprivation.
Key findings
- Higher ADI was consistently associated with prolonged length of stay, greater likelihood of nonhome discharge, and increased odds of emergency department visits.
- More deprived patients had worse absolute postoperative PROMs and were less likely to reach acceptable symptom states, despite comparable improvement.
- ADI was not associated with failure to achieve the minimum clinically important difference; all groups achieved it across the reported outcome domains.
- Higher ADI was associated with increased odds of medical complications; limited evidence suggested more reoperations and periprosthetic joint infection within 90 days and more aseptic revision beyond 90 days.
Why it matters
The review highlights that neighborhood-level deprivation is associated with postoperative resource needs and complications after hip and knee replacement, while differences in absolute patient-reported status do not necessarily reflect less improvement. Considering social and structural context may help interpret outcome variation and identify where additional support could be relevant, although the review does not establish that deprivation itself causes these outcomes.
What to keep in mind
The included studies were heterogeneous, so results were synthesized qualitatively and no meta-analysis was performed. Evidence on implant survivorship was limited.