Archives of Orthopaedic and Trauma Surgery - 2026-03-03 - Journal Article
Impact of neighborhood socioeconomic deprivation on implant complications after unicompartmental knee arthroplasty: a propensity-matched cohort study.
Gordon AM, Nian P, Baidya J, Mont MA
Topics
Key Takeaway
High ADI (socioeconomically disadvantaged) UKA patients showed no difference in 2-year all-cause revision (3.04% vs. 2.86%, OR 1.07) or PJI rates compared to low ADI patients, but incurred significantly higher day-of-surgery costs ($5,336 vs. $4,118).
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study asked whether neighborhood socioeconomic deprivation, measured by ADI, predicts implant-related complications after primary UKA for OA. Using a nationwide claims database with 1:1 propensity matching on age, sex, and Elixhauser Comorbidity Index, the authors compared 2-year complication rates and costs between high and low ADI cohorts. No significant differences were found in PJI, aseptic loosening, MUA, or all-cause revision, though high-ADI patients had paradoxically lower periprosthetic fracture rates (0.21% vs. 0.40%, OR 0.53) and consistently higher perioperative costs.
Key Limitation
Claims data cannot capture surgeon volume, implant design, or alignment metrics, which are primary drivers of UKA failure and could confound the cost differential observed between ADI groups.
Original Abstract
INTRODUCTION
Although previous studies have examined total joint arthroplasties (TJA), research on the association between the Area Deprivation Index (ADI) and outcomes following unicompartmental knee arthroplasty (UKA) remains limited. This study evaluates outcomes following UKA and whether patients with higher ADIs (indicating greater socioeconomic disadvantage) are at increased risk for implant-related complications.
METHODS
A retrospective analysis was performed using a nationwide claims database from 2010 to 2022. The ADI was used to categorize patients into high and low ADI groups. A total of 26,058 primary UKA patients for osteoarthritis were 1:1 propensity-score matched by age, gender, and Elixhauser Comorbidity Index (ECI). Primary endpoints included 2-year implant-related complications and costs. Multivariable logistic regression models computed the odds ratios (OR) for the association between ADI and 2-year implant complications. P values < 0.001 were significant.
RESULTS
Patients undergoing UKA with higher ADIs experienced no difference in the incidence and odds of implant-related complications within 2 years compared to those with lower ADIs. Periprosthetic fractures were less common in the high ADI group (0.21% versus 0.40%; OR: 0.53, P = 0.008). Periprosthetic joint infections (PJIs) (1.27% versus 1.33%; OR: 0.95, P = 0.701), aseptic loosening (1.14% versus 1.05%; OR: 1.08, P = 0.512), manipulations under anesthesia (MUA) (1.10% versus 0.92%; OR: 1.20, P = 0.153), or all-cause revisions (3.04% versus 2.86%; OR: 1.07, P = 0.378) were similar between groups. Patients in the higher ADI cohort had significantly higher day of surgery ($5,336 vs. $4,118;P < 0.0001) and 90-day costs ($7,462 vs. $6,431; P < 0.0001) after propensity-matching and adjustment for measured comorbidities.
CONCLUSION
Patients undergoing UKA of higher ADIs did not experience significant differences in implant-related complications compared to those of lower ADIs. Socioeconomic disadvantage alone is not a major determinant of early implant-related outcomes following UKA. These findings support equitable patient selection and treatment decisions based on clinical indications rather than socioeconomic proxies of patient complexity.
LEVEL OF EVIDENCE
III.