Socioeconomic Status Affects Patient-Reported Outcome Measures in Total Hip and Knee Arthroplasty: A Retrospective Dutch Registry Study

Abstract

Background: To determine the association between socioeconomic status (SES) and patient-reported outcome measures in a Dutch cohort who have undergone total hip arthroplasty (THA) or total knee arthroplasty (TKA).

Methods: A retrospective national registry study of all patients who underwent primary THA or TKA between 2014 and 2020 in the Netherlands was performed. Linear mixed effects regression models were used to assess the association between SES and patient-reported outcome measures for THA and TKA patients separately. The following measures were collected: numeric rating scale for pain, Oxford Hip/Knee Score, Hip/Knee disability and Osteoarthritis Outcome Score, and the EuroQol 5-Dimensions questionnaire. Sex, age, body mass index, American Society of Anesthesiologists classification, Charnley classification, and smoking status were considered as covariates in the models.

Results: THA patients (n = 97,443) were on average 70 years old with a body mass index of 27.4 kg/m², and TKA patients (n = 78,811) were on average 69 years old with a body mass index of 29.7 kg/m². Preoperatively, patients with a lower SES undergoing THA or TKA reported more severe symptoms and lower health-related quality of life. At 1-year follow-up, they also reported lower scores and less improvement over time compared to patients with a higher SES.

Conclusions: Patients with lower SES report worse symptoms when admitted for surgery and less improvement after surgery. Future research must address potentially mediating factors of the association between SES and symptom reporting such as access to surgery and rehabilitation, subjectivity in reporting, and patient expectation for THA and TKA outcomes.

Keywords: Oxford Knee Score; deprivation; patient-reported outcome measures; socioeconomic status; total hip arthroplasty; total knee arthroplasty.