Sociodemographic Differences in Long-Term Function After Total Hip and Knee Arthroplasty: A Scoping Review

This scoping review summarizes the evidence regarding sociodemographic disparities in long-term ( $\ge$ 6 months postoperative) functional outcomes after total hip and knee arthroplasty (THA/TKA). Five databases were searched by a librarian. US-based original research articles that reported on long-term functional outcomes after THA/TKA by sex, race, ethnicity, socioeconomic status, and/or geography were included. Seventy-nine articles met inclusion criteria. Fifty-four articles reported on sex disparities, with 60% of post-THA and 51% of post-TKA outcomes finding that men had a better long-term functional outcome than women. Across the 34 articles and 72 outcomes that examined the variable of race or ethnicity, 63% of post-THA outcomes and 69% of post-TKA outcomes found White patients had better long-term function compared to minoritized patients. In the 24 articles and 47 outcomes that examined socioeconomic status (SES) in relation to long-term function, 63% of post-THA and 71% of post-TKA outcomes indicated higher SES was associated with better long-term function. Only 3 of the 79 studies looked at geography. None found significant disparities. The evidence from our sample shows that disparities in long-term functional outcomes post-THA/TKA likely exist for different racial, ethnic, and socioeconomic groups. There is a lack of data on smaller racial and ethnic minority populations, rural communities, and the way sociodemographic variables may interact with one another. Comparisons across studies were limited due to variation in the outcome measures used and length of follow-up. Additional research should identify patients at risk of decreased long-term function after THA/TKA and protocols to enhance their functional recovery.