title: Socioeconomic status affects the early outcome of total hip replacement.
abstract: This prospective study assessed the effect of social deprivation on the Oxford hip score at one year after total hip replacement. An analysis of 1312 patients undergoing 1359 primary total hip replacements for symptomatic osteoarthritis was performed over a 35-month period. Social deprivation was assessed using the Carstairs index. Those patients who were most deprived underwent surgery at an earlier age (p = 0.04), had more comorbidities (p = 0.02), increased severity of symptoms at presentation (p = 0.001), and were not as satisfied with their outcome (p = 0.03) compared with more affluent patients. There was a significant improvement in Oxford scores at 12 months relative to pre-operative scores for all socioeconomic categories (p < 0.001). Social deprivation was a significant independent predictor of mean improvement in Oxford scores at 12 months, after adjusting for confounding variables (p = 0.001). Deprivation was also associated with an increased risk of dislocation (odds ratio 5.3, p < 0.001) and mortality at 90 days (odds ratio 3.2, p = 0.02). Outcome, risk of dislocation and early mortality after a total hip replacement are affected by the socioeconomic status of the patient.
authors.affiliation: Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK. nickclement@doctors.org.uk
authors.forename: N D
authors.initials: ND
authors.lastname: Clement
authors.forename: A
authors.initials: A
authors.lastname: Muzammil
authors.forename: D
authors.initials: D
authors.lastname: Macdonald
authors.forename: C R
authors.initials: CR
authors.lastname: Howie
authors.forename: L C
authors.initials: LC
authors.lastname: Biant
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D054624:Health Status Disparities; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D017060:Patient Satisfaction; D011446:Prospective Studies; D020127:Recovery of Function; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D016896:Treatment Outcome