Background While socioeconomic factors such as income, education level, and insurance coverage are known to affect orthopaedic outcomes, their individual impact on short-term complications and long-term revision risks after total hip arthroplasty (THA) remains unclear. This study evaluates how these variables influence complication rates and healthcare costs following THA. Methods A retrospective cohort analysis was conducted using the PearlDiver database. Patients who underwent THA for osteoarthritis between 2011 and 2020 were identified and categorized by insurance type, mean family income (MFI: <75, 000 vs ≥75, 000), and educational attainment (EA) in their zip code of residence. Cohorts were matched 1: 1 by age, sex, and Charlson Comorbidity Index. Ninety-day complications and two-year revision rates were evaluated using univariate and multivariate regression. Ten-year revision risk was assessed using Kaplan-Meier survival analysis and Cox proportional hazards models. Total costs of care were compared using Student's t-tests. A p-value <0. 05 was considered statistically significant. Results A total of 431, 087 THA patients were included. Patients with low MFI, commercial insurance, and low EA had significantly higher healthcare expenditures postoperatively. Low MFI and low EA patients experienced higher 90-day readmissions, ED visits, and overall complications. Medicaid patients had the highest odds of wound-related and overall complications. Low MFI was associated with increased revision risk for PJI and PPF at 2 years. Across both 2- and 10-year follow-up, Medicare was linked to higher all-cause and instability-related revision risk, and Medicaid to increased all-cause revision and revision for PJI and mechanical loosening. Low EA remained a consistent risk factor for all-cause revision and revision due to mechanical loosening and instability at both time points. Conclusion Income, education, and insurance-based disparities were linked to increased complications, higher revision rates, and elevated costs after THA. Addressing these socioeconomic factors may help reduce inequities and improve outcomes in hip arthroplasty care.
Charles Nelson (Thu,) studied this question.