Socioeconomic Disparities in Outcomes After Primary Total Hip Arthroplasty: A Propensity-Matched Multi-Institutional Study

Abstract

Background Socioeconomic disadvantage has been associated with poorer outcomes following total hip arthroplasty (THA). This study evaluated the relationship between social determinants of health (SDoH) and short- and long-term postoperative outcomes after primary THA. Methods A retrospective cohort study was conducted using the TriNetX Dataworks-USA network. Adult patients undergoing elective primary THA were identified and stratified based on the presence of at least 1 International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) SDoH Z-code (Z55–Z65). Cohorts were matched in a 1:1 ratio using greedy nearest-neighbor propensity score matching with a caliper of 0.1 standard deviations of the logit of the propensity score, adjusting for age, sex, and medical comorbidities. Standardized mean differences <0.1 were considered indicative of adequate covariate balance. Postoperative outcomes evaluated included superficial surgical site infection, deep vein thrombosis, sepsis, myocardial infarction, and all-cause mortality at 30 days, 90 days, and 1 year following surgery. Risk ratios with 95% confidence intervals were calculated. Results After matching, 15,922 patients remained in each cohort. Patients with SDoH risk factors demonstrated significantly increased risks of superficial surgical site infection, deep vein thrombosis, sepsis, myocardial infarction, and all-cause mortality at multiple postoperative time points compared with controls. Elevated mortality risk persisted through 1 year postoperatively. Conclusions Socioeconomic disadvantage, as identified by SDoH Z-codes, was associated with worse short- and long-term outcomes following primary THA. These findings support the incorporation of social risk factors into perioperative risk stratification and optimization strategies.