Riddle Daniel L, Johnson Maya, Ghomrawi Hassan
From the Departments of Physical Therapy, Orthopaedic Surgery and Rheumatology (Riddle), the Orthopedic Surgery, Virginia Commonwealth University, Richmond, VA (Johnson), and the Department of Orthopaedic Surgery Heersink School of Medicine University of Alabama at Birmingham, Birmingham, AL (Ghomrawi).
J Am Acad Orthop Surg. 2025 Jul 18. doi: 10.5435/JAAOS-D-25-00089.
There is growing evidence on the relationship between social determinants of health (SDOH) dimensions and utilization and outcomes of joint arthroplasty; however, this literature is not currently guided by a conceptual framework that is specific to this patient population. The purposes of our study were to (1) present a comprehensive evidence-driven conceptual framework of SDOH specific to hip and knee arthroplasty and (2) conduct a narrative systematic review of SDOH literature to assess the extent of SDOH coverage and inform the likely directionality of association between proposed variables and joint arthroplasty outcomes.
Existing SDOH conceptual frameworks were reviewed to identify all domains relevant to joint arthroplasty. A systematic narrative review of the hip/knee arthroplasty literature was then conducted in PubMed in accordance with PRISMA principles to inform the extent to which SDOH dimensions are covered and the directionality of associations.
The final proposed conceptual framework identified seven dimensions from both Healthy People 2030 and Luong et al. Our narrative review found 25 articles, and most examined about half of the proposed SDOH domains. Only two of 26 studies accounted for all seven domains. The directionality of multivariable associations was reasonably consistent across studies for person-level dimensions but generally not for Healthy People 2030 dimensions.
Our proposed conceptual framework is the first to describe a comprehensive set of SDOH dimensions. Application of the framework to future research will likely lead to a comprehensive assessment of the role of SDOH in potentially influencing a variety of arthroplasty outcomes.
关于健康的社会决定因素（SDOH）维度与关节置换术的利用情况及结果之间的关系，证据越来越多；然而，目前该文献并未以针对这一患者群体的概念框架为指导。我们研究的目的是：（1）提出一个针对髋膝关节置换术的全面的、基于证据的SDOH概念框架；（2）对SDOH文献进行叙述性系统综述，以评估SDOH的涵盖范围，并了解所提出的变量与关节置换术结果之间可能的关联方向。
对现有的SDOH概念框架进行综述，以确定与关节置换术相关的所有领域。然后根据PRISMA原则在PubMed上对髋/膝关节置换术文献进行系统的叙述性综述，以了解SDOH维度的涵盖程度和关联方向。
最终提出的概念框架从《健康人民2030》和Luong等人的研究中确定了七个维度。我们的叙述性综述发现了25篇文章，大多数文章研究了大约一半的SDOH领域。26项研究中只有两项涵盖了所有七个领域。在个体层面维度上，多变量关联的方向在各项研究中相当一致，但在《健康人民2030》维度上通常并非如此。
我们提出的概念框架是第一个描述一套全面的SDOH维度的框架。将该框架应用于未来的研究可能会全面评估SDOH在潜在影响各种关节置换术结果方面的作用。
