The effect of socioeconomic status on clinical outcomes and implant survivorship after revision shoulder arthroplasty

Abstract

Background

Low socioeconomic status (SES) has been shown to correlate with poorer preoperative and postoperative pain and functional scores in patients undergoing joint arthroplasty. The aim of this study was to investigate the effect of SES on baseline and postoperative outcome scores and implant survivorship after revision shoulder arthroplasty.

Methods

A retrospective review of a prospectively collected single-institution database was performed to identify patients who underwent revision shoulder arthroplasty. Patient zip codes were used to identify their corresponding national area deprivation index (ADI) rank. A correlation analysis between national ADI rank and preoperative, postoperative, and preoperative to postoperative improvement in range of motion, shoulder strength, and clinical outcome scores in patients with minimum 2-year follow-up was performed. In addition, patients were grouped according to their national ADI rank (0-50, 51-75, and 76-100) to compare achievement of the minimum clinically important difference (MCID), substantial clinical benefit, patient acceptable symptom state, and revision-free implant survivorship.

Results

A total of 141 revision shoulder arthroplasties with a mean follow-up of 5.0 ± 2.8 years were included. No correlation between national ADI rank and any preoperative or postoperative outcome measure was identified. In addition, there was no difference in the achievement of the MCID, substantial clinical benefit, and patient acceptable symptom state for all outcome measures except a greater proportion of patients with an ADI rank between 51 and 75 achieving the MCID for the Constant score (P = .031). There was no difference in implant survivorship between ADI groups (P = .912).

Conclusion

Lower SES was not associated with poorer preoperative or postoperative pain and functional outcomes, neither there is a greater risk of implant failure necessitating rerevision. These findings contrast the previously recognized role of SES on primary joint replacement outcomes, suggesting that other factors such as the failure mode of primary TSA (ie, the indication for revision TSA) may have a greater role in determining the preoperative presentation and prognosis of revision TSA.