Influence of ethnicity and socioeconomic factors on outcome after total hip replacement

Previous studies have documented ethnic differences in the utilization of total hip arthroplasty. Less is known if this operation is performed at the same stage of symptoms and has equal effects in patients with different ethnicity.

We investigated whether patients born outside Sweden report equal effects of operation with the insertion of a total hip replacement in terms of EQ-5D, pain and overall satisfaction as those born in Sweden.

Preoperative and 1-year postoperative data from Swedish Hip Arthroplasty Register, (1216 patients,1216 hips) with primary osteoarthritis of the hip operated between years 2002 and 2006, were analysed. All patients completed the EQ-5D form, filled in a VAS about pain preoperatively and at 1 year postoperatively, when a VAS about overall satisfaction was added.

Before the operation and after adjustment for confounders, patients born abroad reported more problems (dichotomized into no or moderate/severe problems), with self-care (p = 0.01) and anxiety/depression (p = 0.02) in the EQ-5D form than those born in Sweden. They also had more pain (VAS, p = 0.04). One year after the operation and after statistical adjustments, patients born outside Sweden reported lower scores for self-care (p = 0.008) and usual activities (p = 0.001) in the EQ-5D form. They still reported more pain (VAS, p = 0.02), but no significant difference concerning degree of satisfaction (p = 0.3).

Our finding of more preoperative disability and pain (VAS) before the operation in patients born abroad might depend on cultural differences, communication problems and differences in indications. Even if the effect of the total hip replacement was good, patients born abroad scored less for some of the items at 1 year. We think that this patient group could benefit from improved pre- and postoperative information and other measures to facilitate and improve their rehabilitation.