The Impact of Socioeconomic Status on Implant Selection for Patients Undergoing Hip Arthroplasty

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Michael Olsen
Michael Neufeld
Michael Sellan
Zachary Morison
Emil H. Schemitsch

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Abstract

Hip resurfacing arthroplasty (HRA) is an alternative to total hip arthroplasty (THA) that preserves proximal femoral bone stock. Patient socioeconomic status (SES) has been demonstrated to impact access to care for numerous healthcare interventions but little is known of its impact on HRA when compared to THA. The aim of this study was to investigate whether there are disparities in SES for patients receiving HRA or THA. A retrospective database review was conducted comprising 617 hip arthroplasty patients (310 HRA, 307 THA). Patient postal code was used as a surrogate marker for patient SES and referenced against Canada Census Tract data to determine patient income. Patients greater than 70 years of age or who underwent THA as revision or for fractures were excluded from the study. There were 465 patients included in the analysis comprised of 273 HRA and 192 THA patients. HRA patients ($33,240, SD $8,206) had a significantly higher mean income than THA patients ($29,365, SD $7,119, p<0.001). The percentage of patients that underwent HRA compared to THA increased as patient SES increased. Patients with an income greater than $25,000 were significantly more likely to undergo HRA rather than THA (OR ≥1.76), compared to patients with an income less than $25,000 in which THA was more likely. There appears to be a disparity in SES between patients who receive HRA and THA. Further work is needed to better understand the factors that influence the choice of hip replacement for patients requiring surgical intervention.