title: Prospective analysis of rural-urban differences in demographic patterns and outcomes following total joint replacement.
abstract: OBJECTIVE
  Little is known about whether rural-urban differences exist in patients after hip and knee joint replacement surgery. We compared patient characteristics, pain and functional outcomes of rural and urban patients undergoing joint replacement surgery in a single high-volume metropolitan centre.
  
  
  METHODS
  Prospective cohort study conducted in patients who underwent primary elective hip (THJR) or knee replacement (TKJR) between 1 January 2006 and 31 December 2009.
  
  
  METHODS
  A university-affiliated tertiary referral centre situated in the central metropolitan region of Melbourne, Australia.
  
  
  METHODS
  One thousand nine hundred fifty-five consecutive patients undergoing primary total joint replacement.
  
  
  METHODS
  Pain and function were assessed preoperatively and 12 and 24 months postoperatively. The main independent variable was geographic location specifically comparing patients residing in rural/regional compared with urban communities.
  
  
  RESULTS
  A total of 2193 primary joint replacements were performed (981 THJR and 1212 TKJR) in 1955 patients. Rural patients presented at a younger age and with earlier radiographic disease than their urban counterparts. There was a higher rate of rheumatoid arthritis among rural patients presenting for TKJR. There was no difference in pain and function scores between groups at 12 and 24 months post-surgery.
  
  
  CONCLUSIONS
  In our series of 1955 patients undergoing total hip and knee joint replacement surgery, rural patients presented at a younger age and an earlier stage of disease progression. At 24 months, rural patients had pain and functional outcomes as good as their urban counterparts. More research is required to determine which factors lead to the early presentation of rural patients.
authors.affiliation: Department of Orthopaedics, St. Vincent's Hospital Melbourne, University of Melbourne, Melbourne, Victoria, Australia; Department of Surgery, St. Vincent's Hospital Melbourne, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Dowsey
authors.forename: Joshua
authors.initials: J
authors.lastname: Petterwood
authors.forename: James P
authors.initials: JP
authors.lastname: Lisik
authors.forename: Jane
authors.initials: J
authors.lastname: Gunn
authors.forename: Peter F M
authors.initials: PF
authors.lastname: Choong
mesh_terms: D000367:Age Factors; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000453:epidemiology; D011446:Prospective Studies; D020127:Recovery of Function; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012737:Sex Factors; D016896:Treatment Outcome; D019037:Urban Health Services / Q000706:statistics & numerical data*; D014739:Victoria / Q000453:epidemiology
keywords: health outcome; pain and function; rural health; total hip replacement; total knee replacement