Summary

ADI did not significantly influence outcomes following HTO/DFO. These findings suggest HTO/DFO outcomes are not strongly affected by socioeconomic status, unlike other orthopedic procedures. Further research is needed to understand this relationship, but HTO/DFO appears safe and effective across the socioeconomic spectrum.

Abstract

Purpose

Socioeconomic status (SES) impacts health outcomes, including orthopedic procedures. The Area Deprivation Index (ADI) measures socioeconomic disadvantage using U.S. Census data on education, employment, housing quality, and poverty. Prior research shows lower SES patients often have worse outcomes post-medical interventions, including joint arthroplasty. This study investigates ADI's relationship with patient-reported outcomes (PROs) at 2-year follow-up post-High Tibial Osteotomy (HTO) and Distal Femoral Osteotomy (DFO) to understand how socioeconomic factors influence recovery.

Methods

A retrospective review of a prospectively-gathered database of patients undergoing isolated HTO or DFO at a single academic institution (July 2012-July 2021) was performed. Patient addresses were used to calculate state and national ADI scores, reflecting socioeconomic deprivation. Higher scores indicate greater deprivation. PRO scores collected pre-surgery and at 2-year follow-up included Tegner Activity Score, International Knee Documentation Committee (IKDC) Score, Lysholm Score, KOOS, and Visual Analog Scale (VAS). Return to work and sports were also assessed. The database included 215 patients, with 166 (77.2%) having complete data. Linear regression analysis compared ADI with each PRO. Logistic regression assessed ADI’s association with return to sports and work. A p-value <0.05 was considered significant.

Results

The study included 166 patients (mean BMI 29.21±5.60, age 37.94±10.89 years; 113 males, 53 females). No significant associations were found between ADI and PRO measures (IKDC, Lysholm, KOOS, VAS scores) at state and national levels. ADI showed no significant association with return to work or sports. Socioeconomically disadvantaged groups did not report worse PROs at 2 years post-HTO/DFO compared to less disadvantaged groups.

Conclusion

ADI did not significantly influence outcomes following HTO/DFO. These findings suggest HTO/DFO outcomes are not strongly affected by socioeconomic status, unlike other orthopedic procedures. Further research is needed to understand this relationship, but HTO/DFO appears safe and effective across the socioeconomic spectrum.