Total Joint Arthroplasty in Homeless Patients at an Urban Safety Net Hospital

Abstract

Introduction: Homelessness is a key social determinant of health, and the patient population has grown to over 580,000. Total joint arthroplasty (TJA) is an effective treatment of symptomatic end-stage osteoarthritis of the hip and knee and has been shown to improve health-related quality of life in the general population. However, the literature on the outcomes of TJA among homeless patients is limited. Methods: We retrospectively reviewed 442 patients who underwent primary, unilateral TJA between June 1, 2016, and August 31, 2017, at an urban, tertiary, academic safety net hospital. Based on self-reported living status, we classified 28 homeless patients and 414 control nonhomeless patients. Fisher exact tests, Student t-tests, and multivariate logistic regression were used to compare the demographics, preoperative conditions, and surgical outcomes between the two groups. Results: The homeless group were younger, more often male, and smokers; had alcohol use disorder; and used illicit drugs. After controlling for age, sex, and preoperative medical and social conditions, homeless patients were 15.83 times more likely to have an emergency department visit (adjusted odds ratio, 15.83; 95% confidence interval, 5.05 to 49.59; P , 0.0001) within 90 days but had similar rates of readmission (P = 0.25), revision surgery (P = 0.38), and prosthetic joint infection (P = 0.25) when compared with nonhomeless patients. Discussion: Although homeless patients did not have higher rates of readmission or revision surgery, homelessness still presents unique challenges for the TJA patients and providers. With careful preoperative optimization and collaborative support, however, the benefits of TJA may outweigh the risk of poor outcomes for these patients.

Osteoarthritis and Poverty: Challenges and Opportunities

“…In addition to multiple health impacts, being homeless, having obesity and an unqualified job can all interact to raise the risk and progression of osteoarthritis and needs to be addressed accordingly [51][52][53][54][55][56]. These social factors are not new, and may clearly induce an ongoing or unexpectedly high socioeconomic burden on many diagnosed as having osteoarthritis.…”

Risk factors for emergence agitation during the awakening period in elderly patients after total joint arthroplasty: a retrospective cohort study

“…Total joint arthroplasty (TJA) is a successful treatment protocol for end-stage knee and hip osteoarthritis (OA). 9 Annually, more than 1 million people undergo TJA in the USA. 10 As the population ages, the demand for TJA surgery is expected to increase substantially in the coming years.…”

“…Total joint arthroplasty (TJA) is a successful treatment protocol for end-stage knee and hip osteoarthritis (OA) 9. Annually, more than 1 million people undergo TJA in the USA 10.…”

The Impact of Homelessness, Substance Use, and Mental Illness on Surgical Inpatient Outcomes in Australia

“…Similarly, Bennett et al 15 described the challenges created by the lack of social and rehabilitative services available to homeless patients following joint replacement surgery. Looking at postoperative surgical outcomes in PEH, Niu et al, 16 in their small cohort study of patients undergoing arthroplasy, found no increased risk of readmission, revision, or joint infection. However, on a much larger analysis of outcomes of coronary artery bypass surgery in U.S. veterans, Chandra et al 17 found homelessness to be an independent predictor of 30-day mortality.…”