Pagadala Manasa, Bergman Rachel, Selph T Jacob, Franklin Patricia, Edelstein Adam I, Suleiman Linda I
Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Division of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA.
Arthroplast Today. 2025 Jun 9;33:101702. doi: 10.1016/j.artd.2025.101702. eCollection 2025 Jun.
Total knee arthroplasty (TKA) is an effective treatment for advanced osteoarthritis, but disparities in its utilization exist, particularly by gender, race, socioeconomic status, and geography. Social determinants of health may contribute to these disparities. This study examines the relationship among the Social Vulnerability Index (SVI), a measure of social determinants of health, and the likelihood of receiving a surgeon's recommendation for TKA.
This prospective, observational study included 314 patients with primary knee osteoarthritis deemed "appropriate" for TKA based on the American Academy of Orthopaedic Surgeons Appropriate Use Criteria. Patients were recruited from 4 fellowship-trained arthroplasty surgeons at a single academic hospital in Chicago. The primary outcome was whether patients received a surgeon recommendation for TKA, analyzed in relation to their SVI. Bivariate and multivariable analyses were performed, adjusting for patient demographics, body mass index, Charlson Comorbidity Index, and surgeon factors.
Of the 314 patients appropriate for TKA by Appropriate Use Criteria guidelines, 39.2% received a surgeon recommendation. Patients with lower SVI scores were more likely to receive a recommendation (0.6596 vs 0.7556, = .284). Multivariable analysis showed that lower SVI scores were independently associated with higher odds of a surgeon recommendation (odds ratio [OR]: 0.705, = .028), particularly in the subcategories of socioeconomic status (OR: 0.754, = .034) and household characteristics (OR: 0.803, = .049).
Lower SVI scores are associated with increased likelihood of receiving a TKA recommendation, highlighting the impact of social vulnerability on clinical decision-making and the need for further investigation into mitigating biases in surgical decisions.
全膝关节置换术（TKA）是治疗晚期骨关节炎的有效方法，但在其应用方面存在差异，尤其是在性别、种族、社会经济地位和地理位置方面。健康的社会决定因素可能导致这些差异。本研究探讨了社会脆弱性指数（SVI）（一种衡量健康社会决定因素的指标）与接受外科医生TKA推荐的可能性之间的关系。
这项前瞻性观察性研究纳入了314例根据美国矫形外科医师学会的适当使用标准被认为“适合”进行TKA的原发性膝关节骨关节炎患者。患者从芝加哥一家学术医院的4名接受过 fellowship 培训的关节置换外科医生处招募。主要结局是患者是否接受了外科医生的TKA推荐，并根据其SVI进行分析。进行了双变量和多变量分析，并对患者人口统计学、体重指数、Charlson合并症指数和外科医生因素进行了调整。
在314例符合适当使用标准指南的适合TKA的患者中，39.2%接受了外科医生的推荐。SVI得分较低的患者更有可能接受推荐（0.6596对0.7556，P =.284）。多变量分析表明，较低的SVI得分与外科医生推荐的较高可能性独立相关（优势比[OR]：0.705，P =.028），特别是在社会经济地位子类别（OR：0.754，P =.034）和家庭特征子类别（OR：0.803，P =.049）中。
较低的SVI得分与接受TKA推荐的可能性增加相关，突出了社会脆弱性对临床决策的影响以及进一步调查以减轻手术决策中的偏差的必要性。
