Socioeconomic factors influencing periacetabular osteotomies in patients with acetabular dysplasia in Boston, Massachusetts

Abstract

This study aimed to investigate the association between sociodemographic factors and pre- and postoperative outcomes in patients who underwent periacetabular osteotomy (PAO) for acetabular dysplasia. A retrospective analytical clinical cohort study analyzed 1165 PAO surgeries at Boston Children’s Hospital, Massachusetts. Exclusion criteria were prior hip trauma or neuromuscular or connective tissue disorders, resulting in exclusion of 691 procedures. Descriptive sociodemographic data, notably age at time of surgery, Area Disability Index (ADI), gender, race, ethnicity, local vs interstate or international, and language spoken at home, were recorded in respect of patients undergoing the remaining 474 procedures. Outcome measures were recorded for 382 PAOs with completed preoperative hip questionnaires. Outcome measures were number of days to surgery, satisfaction with surgery, reoperations, and patient-reported scales being UCLA Activity score, HOOS score, MHHS score, SF-12 and EQ-VAS. Preoperative and postoperative clinical examination and radiographic outcomes were recorded. The study used repeated measures mixed modelling to assess the association between individual sociodemographic factors and outcomes. The study found that some sociodemographic factors were associated with patients' pain and function, but not with satisfaction with surgery, complications, or reoperation rates. The study found that patients' experience of pain and function were associated with both ADI (National) and race, suggesting an interplay between these two factors in socioeconomic disadvantage. Ethnicity was only found to be associated with higher age at time of presentation. However, the lack of other associations may have been influenced by the small size of the Hispanic population in the study. There were mixed associations found between gender and postoperative outcomes. The study supported the hypothesis that some sociodemographic factors, particularly race and ADI (National), are associated with worse patient-reported outcomes and worse daily function at time of presentation. This highlights the need for supportive initiatives for vulnerable patient cohorts. The study suggests that once patients undergo PAO surgery, postoperative outcomes may not be associated with sociodemographic factors; however, the lack of findings highlights the need to explore the impact of sociodemographic factors on postoperative outcomes.