FP17.5 Socioeconomic Disadvantage Associated with Lower Rates of Clinical Benefit Achievement and Higher Risk of Adverse Events After Hip Arthroscopy: A Systematic Review

Abstract

Abstract ICL17 - The Full Picture: Shaping the Future of Global Hip Preservation, Ground Floor Session Room (BMCC Level 0), October 9, 2026, 14:00 - 16:00 Purpose Socioeconomic status (SES) and social determinants of health (SDOH) are increasingly recognized as key drivers of musculoskeletal outcomes. Disparities in access to care, insurance status, and neighborhood environment may influence recovery following hip arthroscopy. The purpose of this systematic review was to evaluate the association between SES/SDOH and postoperative outcomes following hip arthroscopy. Methods This systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO. PubMed, Scopus, and Embase were systematically searched in July 2025. Eligible studies included retrospective or prospective cohorts evaluating outcomes after hip arthroscopy stratified by SES or SDOH measures, including the Area Deprivation Index (ADI), Social Deprivation Index (SDI), and insurance status. Outcomes included patient-reported outcome measures (PROMs), minimum clinically important difference (MCID), Patient Acceptable Symptomatic State (PASS), substantial clinical benefit (SCB), complications, revision procedures, and conversion to total hip arthroplasty (THA). Results Seven studies met inclusion criteria. Mean patient age ranged from approximately 31 to 39 years, with female representation ranging from 47% to 62.5%. Disadvantaged patients more frequently had public insurance and lower educational attainment. Two of five studies reporting baseline PROMs demonstrated significantly worse preoperative scores in disadvantaged cohorts. Postoperatively, two studies reported significantly worse absolute PROMs in disadvantaged patients compared to more advantaged cohorts, including lower mHHS scores (79.3 vs 90.1, P = .008) and HOS-ADL scores (80.7 vs 87.5, P = .043) at long-term follow-up. MCID achievement demonstrated inconsistent associations, with five of six studies showing no significant difference and one study demonstrating increased odds of MCID with higher deprivation. In contrast, PASS achievement more consistently favored higher SES cohorts, with three of five studies demonstrating significantly lower PASS achievement in disadvantaged patients, including lower mHHS PASS rates at long-term follow-up (55.6% vs 92.3%, P = .002). Two studies evaluated SCB, both demonstrating reduced achievement in disadvantaged cohorts, including one study showing significantly lower rates (51.6% vs 65.9%, P < .001). Two studies evaluated complications, with one reporting no significant differences and the other identifying higher complication rates in disadvantaged patients (12.5% vs 3.9%, P = .03). Conclusion Socioeconomic disadvantage is associated with worse baseline outcomes and lower likelihood of achieving clinically meaningful outcome thresholds, including PASS and SCB, following hip arthroscopy. Associations with complications remain inconsistent. Clinical Relevance Incorporating SDOH into preoperative risk stratification may help identify at-risk patients and guide targeted interventions to improve equitable outcomes.