Social Deprivation as a Risk Factor for Manipulation Under Anesthesia Following Total Knee Arthroplasty

Area of Science:

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

Background:

• Manipulation under anesthesia (MUA) is a complication following total knee arthroplasty (TKA).
• Previous studies indicate Black patients and socially deprived individuals face higher MUA risks.
• Understanding the impact of social deprivation on TKA outcomes is crucial for health equity.

Purpose of the Study:

• To investigate the association between area-level and person-level social deprivation and the odds of MUA within one year after TKA.
• To analyze how the Social Deprivation Index (SDI) and dual Medicare/Medicaid eligibility relate to MUA risk.

Main Methods:

• Retrospective cohort study of fee-for-service Medicare beneficiaries aged 65+ undergoing primary elective TKA (2016-2020).
• Area-level social deprivation measured by county-level Social Deprivation Index (SDI).
• Person-level social deprivation assessed by dual Medicare/Medicaid eligibility; analyzed using mixed-effects generalized linear models.

Main Results:

• The most socially deprived quintile showed significantly lower odds of MUA compared to less deprived quintiles (ORs ranging from 0.70 to 0.77).
• Dual Medicare/Medicaid eligibility was not significantly associated with MUA.
• No significant differences in MUA were found for the person-level deprivation indicator.

Conclusions:

• Higher social deprivation at the area level was unexpectedly associated with lower odds of MUA after TKA.
• This finding may suggest potential barriers in accessing postoperative care for highly deprived populations, rather than improved outcomes.
• Further investigation is warranted to elucidate the complex relationship between social deprivation and TKA outcomes.