A Scoping Review of Sociodemographic Differences in Geriatric Orthopedic Surgery Research

Given the association between advanced age and musculoskeletal conditions treated with orthopedic surgery, as well as the presence of established health differences in orthopedic care among vulnerable populations, this review aimed to (1) qualitatively assess the extent to which geriatric orthopedic research includes sociodemographic differences, and (2) outline conceptual and methodological gaps in existing research.

We conducted a scoping review of original research published between January 2017 and December 2023 and indexed in Medline (Ovid), Embase, Scopus, and CINAHL databases. We included studies evaluating sociodemographic differences in total knee/hip arthroplasty, hip fracture, and vertebral compression fracture. The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines.

Of the initial 1780 citations, 203 met inclusion/exclusion criteria. The number of studies addressing sociodemographic differences remained relatively small and stable across years, peaking at 36 in 2020. Most studies were retrospective (84.7%, n = 172), fewer were prospective (13.8%, n = 28), two were interventional, and one was qualitative. The most commonly included sociodemographic characteristics were race (60.1%, n = 122), age (36.5%, n = 74), and ethnicity (25.6%, n = 52). No studies evaluated sexual identity, cultural factors, and disability status as primary objectives. Study outcomes focused on utilization/cost/throughput (46.3% n = 94), complications/adverse events (45.3%, n = 92), and surgical outcomes (29.0%, n = 59). Geriatrics-focused outcomes (function, cognition, mental health, quality of life, and social support) were rarely evaluated. Based on a multilevel research framework, most studies focused on individual-level factors (95.1%, n = 193) and biological domains (681.8%, n = 166).

This scoping review highlights significant gaps in the inclusion of sociodemographic differences in geriatric orthopedic surgery research. Future studies should move beyond retrospective demographic data to include patient-centered outcomes, qualitative studies that can capture the patient and caregiver experience, and interventional studies that aim to improve health outcomes for all older adults.