Social Deprivation as a Driver of Disparities in Arthroplasty: A Contemporary Review.

Abstract

Purpose of review: While social determinants of health are known to contribute to disparities in orthopaedic care, associations between social deprivation and total joint arthroplasty (TJA) outcomes remain unclear. This review assessed the relationship between social deprivation and multiple aspects of total joint arthroplasty, including access to care, early postoperative outcomes, resource utilization, and patient-reported functional recovery.

Recent findings: Recent studies have increasingly used composite deprivation indices including the Area Deprivation Index (ADI), Social Vulnerability Index (SVI), Social Deprivation Index (SDI), and Distressed Communities Index (DCI) to examine disparities in TJA care. Higher levels of social deprivation were consistently associated with reduced arthroplasty utilization, increased early postoperative complications, longer hospital stays, higher costs, and greater likelihood of non-home discharge. Associations with emergency department use were frequent, whereas findings related to readmissions were mixed. Relationships between deprivation and patient-reported outcomes were less consistent. Across multiple studies, deprivation was not uniformly associated with failure to achieve clinically meaningful improvement but was more frequently linked to failure to achieve patient-acceptable symptom states and challenges in sustaining functional recovery. Social deprivation is an important determinant of access, perioperative outcomes, and healthcare utilization following TJA, with ADI demonstrating the most consistent association. Although socially deprived patients generally achieve meaningful postoperative improvement, they are less likely to reach optimal recovery thresholds. Incorporating deprivation measures into perioperative planning may help identify patients who would benefit from targeted interventions. Future studies should standardize index use and evaluate strategies to reduce socioeconomic disparities in arthroplasty outcomes.