Kazi Omair, Alvero Alexander B, Castle Joshua P, Vogel Michael J, Boden Stephanie A, Wright-Chisem Joshua, Nho Shane J
Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois.
Department of Orthopaedic Surgery, Henry Ford Health, Detroit, Michigan.
J Bone Joint Surg Am. 2024 Dec 4;106(23):2232-2240. doi: 10.2106/JBJS.24.00217. Epub 2024 Oct 15.
The purpose of this study was to explore the impact of social deprivation on preoperative characteristics and postoperative outcomes following hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS).
Patients undergoing primary HA for FAIS were identified, and their social deprivation index (SDI) score was assigned on the basis of the provided ZIP code. Quartiles (Q1 to Q4) were established using national percentiles, with Q4 representing patients from the areas of greatest deprivation. Patient-reported outcomes (PROs) were collected preoperatively and at a minimum follow-up of 2 years. Achievement rates for clinically meaningful outcomes, including the minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB), were determined. The incidences of revision HA and conversion to total hip arthroplasty (THA) were recorded. SDI groups were compared with respect to preoperative characteristics and postoperative outcome measures. Predictors of MCID, PASS, and SCB achievement; revision HA; and conversion to THA were identified with use of multivariable logistic regression.
In total, 2,060 hips were included, which had the following SDI distribution: Q1 = 955, Q2 = 580, Q3 = 281, and Q4 = 244. The composition of the included patients with respect to race and/or ethnicity was 85.3% Caucasian, 3.8% African American, 3.7% Hispanic, 1.7% Asian, and 5.4% "other." Patients with more social deprivation presented at a later age and with a higher body mass index (BMI), a longer duration of preoperative hip pain, and greater joint degeneration (p ≤ 0.035 for all). The most socially deprived groups had higher proportions of African American and Hispanic individuals, less participation in physical activity, and greater prevalences of smoking, lower back pain, and Workers' Compensation (p ≤ 0.018 for all). PRO scores and achievement of the PASS and SCB were worse among patients from areas of greater social deprivation (p ≤ 0.017 for all). Age, BMI, activity status, race and/or ethnicity classified as "other," SDI quartile, Workers' Compensation, preoperative back pain, duration of preoperative hip pain, and Tönnis grade were independent predictors of clinically meaningful outcome achievement, revision arthroscopy, and/or THA conversion (p ≤ 0.049 for all).
Individuals with more social deprivation demonstrated inferior postoperative outcome measures. This was driven primarily by preoperative characteristics such as SDI, hip pain duration, joint degeneration, and overall health at presentation. Despite differential outcomes, patients still showed clinical improvement regardless of SDI quartile.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
本研究的目的是探讨社会剥夺对股骨髋臼撞击综合征（FAIS）行髋关节镜检查（HA）术前特征及术后结果的影响。
确定因FAIS接受初次HA的患者，并根据提供的邮政编码分配其社会剥夺指数（SDI）评分。使用全国百分位数建立四分位数（Q1至Q4），Q4代表来自最贫困地区的患者。术前及至少随访2年时收集患者报告结局（PROs）。确定包括最小临床重要差异（MCID）、患者可接受症状状态（PASS）和实质性临床获益（SCB）在内的具有临床意义结局的达成率。记录HA翻修及转为全髋关节置换术（THA）的发生率。比较SDI组的术前特征及术后结局指标。采用多变量逻辑回归确定MCID、PASS和SCB达成、HA翻修及转为THA的预测因素。
共纳入2060例髋关节，其SDI分布如下：Q1 = 955，Q2 = 580，Q3 = 281，Q4 = 244。纳入患者的种族和/或民族构成如下：85.3%为白种人，3.8%为非裔美国人，3.7%为西班牙裔，1.7%为亚洲人，5.4%为“其他”。社会剥夺程度较高的患者就诊时年龄较大、体重指数（BMI）较高、术前髋关节疼痛持续时间较长且关节退变更严重（所有p≤0.035）。社会剥夺程度最高的组中非裔美国人和西班牙裔个体比例较高，体育活动参与较少，吸烟、下背痛和工伤赔偿的患病率较高（所有p≤0.018）。社会剥夺程度较高地区的患者PRO评分以及PASS和SCB的达成情况较差（所有p≤0.017）。年龄、BMI、活动状态、种族和/或民族分类为“其他”、SDI四分位数、工伤赔偿、术前背痛、术前髋关节疼痛持续时间和Tönnis分级是具有临床意义结局达成、关节镜翻修和/或THA转换的独立预测因素（所有p≤0.049）。
社会剥夺程度较高的个体术后结局指标较差。这主要由术前特征如SDI、髋关节疼痛持续时间、关节退变和就诊时的整体健康状况所驱动。尽管结局存在差异，但无论SDI四分位数如何，患者仍表现出临床改善。
预后性III级。有关证据水平的完整描述，请参阅作者指南。
