High Area Deprivation Index is Associated With Not Achieving the Patient-acceptable Symptom State After TKA

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Socioeconomic Determinants of Health

Background:

• The Area Deprivation Index (ADI) quantifies patient socioeconomic deprivation.
• Previous studies linked ADI to increased healthcare utilization post-total knee arthroplasty (TKA).
• The association between ADI and patient-reported outcome measures (PROMs) after TKA remains unclear.

Purpose of the Study:

• To determine if ADI is associated with achieving the minimum clinically important difference (MCID) for Knee Injury and Osteoarthritis Outcome Score (KOOS) pain, Joint Replacement (JR), and Physical Function (PS) short forms after TKA.
• To assess if ADI is associated with achieving patient-acceptable symptom state (PASS) thresholds for KOOS pain, JR, and PS short forms post-TKA.

Main Methods:

• Retrospective analysis of 8,813 patients undergoing unilateral TKA between 2016 and 2021.
• PROMs (KOOS pain, JR, PS) assessed at baseline and 1-year follow-up.
• Multivariable logistic regression analyzed the association of ADI quintiles with MCID and PASS achievement, controlling for demographics.

Main Results:

• ADI was not associated with achieving MCID for KOOS pain, JR, or PS.
• Higher ADI independently increased the risk of not achieving PASS for KOOS pain (OR 1.34) and JR (OR 1.29).
• No significant association was found between higher ADI and not achieving PASS for KOOS PS (OR 1.09).

Conclusions:

• Socioeconomic factors influence patient perception of overall pain and function after TKA, but not perceived improvement.
• Patients from higher deprivation areas may benefit from targeted interventions, such as transportation and care coordination support.
• Further research is needed to understand why socioeconomic disadvantage affects PASS but not MCID achievement post-TKA.