Built Environment Portends Poor Outcomes for Hip Arthroscopy Patients at 2-Year Follow-up

There is a paucity of research on how factors within the social determinants of health (SDOHs), specifically built environment (recreational parks, housing built pre-1980s, and walkability), affect outcomes after hip arthroscopy.

To evaluate the effect of the built environment on patient-reported outcome measures (PROMs) and rates of achieving minimal clinically important difference (MCID) and patient acceptable symptom state (PASS).

Cohort study; Level of evidence, 3.

Patients who underwent hip arthroscopy for symptomatic labral tears were enrolled in this study. Study participants prospectively completed PROM surveys preoperatively and at 3, 6, 12, and 24 months after surgery. Patients were excluded if they were <18 years of age, had radiographic evidence of hip dysplasia (lateral center-edge angle <20°), had Tönnis grade >1, or had prior ipsilateral hip surgery. Patients were retrospectively stratified into built environment (BE; BE_Good, BE_Average, and BE_Poor) cohorts according to the Centers for Disease Control and Prevention's BE percentile.

In total, 203 patients (108 male and 95 female) met the inclusion criteria and were stratified into 3 cohorts: BE_Good (mean BE: 20.4% ± 9.5%), BE_Average (mean BE: 47.8% ± 10.0%), and BE_Poor (mean BE: 74.4% ± 6.0%). At baseline, the BE_Good reported significantly higher scores in all PROMs compared with the BE_Poor cohort (all P < .05). At 2 years, both BE_Good and BE_Average reported significantly higher PROM scores compared with BE_Poor (all P < .05). There were no significant differences between cohorts in achieving MCID values (P > .05). BE_Good reported significantly higher PASS achievement for Hip Outcome Score-Activities of Daily Living (P = .042), Hip Outcome Score-Sports Specific Subscale (P = .013), and Non-Arthritic Hip Score (P = .021) compared with BE_Poor. At 24 months, both BE_Good and BE_Average reported significantly higher rates of achieving PASS for all PROMs (all P < .05), except for the modified Harris Hip Score (P = .156 and P = .410, respectively), compared with BE_Poor.

Patients undergoing hip arthroscopy who reside in a poor built environment reported significantly lower preoperative baseline scores, and this disparity continued at the 24-month follow-up, with lower rates of PASS achievement. However, patients across built environment cohorts improved and achieved MCID at similar rates. These findings suggest that a poor built environment may negatively influence preoperative PROMs but that hip arthroscopy is still beneficial for patients regardless of the built environment.