The Effect of Sex, Race/Ethnicity, and Neighborhood Socioeconomic Disadvantage on Total Hip Arthroplasty Utilization: A Multicenter Cohort Study.

Introduction: Disparities in the management of hip osteoarthritis (OA) exist across sex, race/ethnicity, and socioeconomic status, but their combined effect on total hip arthroplasty (THA) utilization remains unclear. This study evaluates differences in presentation, nonsurgical treatments, and THA rates across two academic centers.

Methods: Patients with primary hip OA seen in 2002 at two tertiary academic centers were included. Demographics, Kellgren-Lawrence grade, Charlson Comorbidity Index (CCI), and nonsurgical treatments were collected. Socioeconomic status was assessed using the social deprivation index, stratified into quartiles (Q4 = most deprived). Chi square, analysis of variance, and t-tests compared demographics and utilization rates. A multivariable model analyzed factors influencing THA likelihood.

Results: Among 456 patients, 328 were recommended for THA for primary hip OA, 63% were female, 6% were Asian, 6% Black, 23% other, 3% unknown, 54% White, and 8% Hispanic. Female patients were older (70.3 ± 8.6 vs. 68.1 ± 9.7 years, P = 0.03). Hispanic patients were younger (62.2 ± 12.1 vs. 70.1 ± 8.7 years, P = 0.0020) with lower CCI (2.20 ± 1.52 vs. 2.93 ± 1.49 vs. 3.28 ± 1.69 P = 0.027). Social deprivation index Q4 patients had greater physical therapy utilization (Q4 79% vs. Q1 62%, P = 0.006). Overall, 79% of patients who were offered THA underwent surgery, with multivariate analysis revealing lower likelihood among females, Black, Asian, and Hispanic patients with higher CCI (P < 0.001), whereas socioeconomically disadvantaged patients were more likely to undergo THA (P < 0.05).

Conclusion: Although THA utilization was high, disparities in presentation age, nonsurgical treatments, and comorbidities suggest differing challenges across populations. Future research should explore drivers of these disparities.

Level Of Evidence: IV retrospective cohort.