The Impact of Frailty and Deprivation on the Likelihood of Receiving Primary Total Hip and Knee Arthroplasty among People with Hip and Knee Osteoarthritis

Abstract

Among people with hip and knee osteoarthritis (OA), increasing deprivation is associated with reduced likelihood of receiving hip and knee arthroplasty (THA, TKA). To assess whether higher levels of frailty in the most deprived neighbourhoods explains the association between greater neighbourhood deprivation and reduced likelihood of receiving THA and TKA among people with hip and knee OA. Longitudinal cohort study. Linked primary and secondary care electronic medical records and national mortality data. 104,913 individuals with incident hip OA and 216,420 with incident knee OA. Frailty was assessed using a frailty index and categorised as fit, mild, moderate, and severe frailty. Neighbourhood deprivation was assessed using the index of multiple deprivation (IMD). Compared to those in neighbourhoods in the least deprived quintile of IMD, those in neighbourhoods in the fourth and fifth quintile of IMD (most deprived), respectively, were less likely to receive THA, adjusted subhazard ratio (95% CI), 0.90 (0.87, 0.93) and 0.77 (0.74, 0.80), over a mean follow up of 4.4 years, with similar results for TKA. Higher levels of frailty at OA diagnosis were associated also with reduced likelihood of receiving THA and TKA. The association, however, between deprivation and likelihood of receiving THA and TKA could not be explained by increased levels of frailty among those living in the most deprived areas. Further work is needed to understand why those in the most deprived areas are less likely to receive THA and TKA.