Socioeconomic status affects the Oxford knee score and Short-Form 12 score following total knee replacement

Abstract

We assessed the effect of social deprivation upon the Oxford knee score (OKS), the Short-Form 12 (SF-12) and patient satisfaction after total knee replacement (TKR). An analysis of 966 patients undergoing primary TKR for symptomatic osteoarthritis (OA) was performed. Social deprivation was assessed using the Scottish Index of Multiple Deprivation. Those patients that were most deprived underwent surgery at an earlier age (p = 0.018), were more likely to be female (p = 0.046), to endure more comorbidities (p = 0.04) and to suffer worse pain and function according to the OKS (p < 0.001). In addition, deprivation was also associated with poor mental health (p = 0.002), which was assessed using the mental component (MCS) of the SF-12 score. Multivariable analysis was used to identify independent predictors of outcome at one year. Pre-operative OKS, SF-12 MCS, back pain, and four or more comorbidities were independent predictors of improvement in the OKS (all p < 0.001). Pre-operative OKS and improvement in the OKS were independent predictors of dissatisfaction (p = 0.003 and p < 0.001, respectively). Although improvement in the OKS and dissatisfaction after TKR were not significantly associated with social deprivation per se, factors more prevalent within the most deprived groups significantly diminished their improvement in OKS and increased their rate of dissatisfaction following TKR.

Disparities in TKA Outcomes: Census Tract Data Show Interactions Between Race and Poverty

“…In our model, disparities in 2-year WOMAC pain and function scores between blacks and whites are minimal when patients live in wealthy communities but are present in communities with high census tract poverty levels. Our study suggests an important association of community poverty on patient-reported outcomes after TKA, and that poverty has a disproportionately strong association with TKA outcomes among black patients than among white patients Our study is consistent with other studies [2,7,8,21], showing a strong interaction between community poverty and race on health outcomes. For example, in a study analyzing the interaction of neighborhood poverty and race as they affect mortality, the effect of increasing poverty was greater for blacks than for whites.…”

“…Blacks in the United States experience more short-term complications and present for TKA later than whites (with more preoperative pain and worse function), and have worse long-term outcomes as measured by pain, function, and patient satisfaction [5,13,23,24]. However, because blacks experience poverty disproportionately [6] and because poverty also is associated with poor TKA outcomes [8,21], the root of the problem remains obscure.…”

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

“…In this section we summarise results from 22 studies of pre-operative BMI, mental health, pain and physical function as predictors of long-term patient-reported outcomes. 46,50,127,[147][148][149][150][151][152][153][154][155][156][157][158][159][160][161][162][163][164][165] One study included important data in a second publication. 166 Details of studies are summarised in Appendix 6 with brief details in Table 5.…”

“…50,147,148,150,[155][156][157][158]160,[163][164][165] Two studies reported data from joint registries, 147,148 five studies included patients from multiple centres 150,[155][156][157][158] and five studies collected data from patients treated at a single centre. 50,160,[163][164][165] Study details are summarised in Table 5.…”

Implementation of Patient-Reported Outcome Measures in U.S. Total Joint Replacement Registries: Rationale, Status, and Plans

“…Both the Swedish and the United Kingdom postoperative surveys are distributed directly to the patients at their homes. The Swedish hip registry uses the brief EQ-5D and reported completion by more than 90% of patients 24 , while the United Kingdom uses the twelve-item Oxford assessment and reported completion by 79% to 85% for various postoperative intervals and patient subgroups [25][26][27][28][29][30][31] . Beyond for total joint replacement, similar PRO completion rates have been reported for a cancer-survivor registry: 85% at six months and 66% at fifteen months postoperatively 32 .…”