- 2026-04
- Orthopaedic journal of sports medicine 14(4)
Study Design
- Type
- Observational
- Sample size
- n = 164
- Population
- 164 patients who underwent primary hip arthroscopy for symptomatic labral tears
- Methods
- Retrospective cohort study comparing patients with college or less education to those with graduate or doctorate education
- Duration
- minimum 8-year follow-up
- Funding
- Unclear
Background
Social determinants of health (SDoH), including education level, are associated with postoperative outcomes and complication rates after orthopaedic surgery.Purpose
To evaluate the relationship between patient preoperative educational attainment (PEA) and (1) SDoH demographics, (2) long-term patient-reported outcomes (PROs), and (3) rates of revision surgery and conversion to total hip arthroplasty (THA) after primary hip arthroscopy.Study design
Cohort study; Level of evidence, 3.Methods
A retrospective cohort study was conducted of patients who underwent hip arthroscopy at a single institution. Patients ≥18 years old with minimum 8-year follow-up PROs who underwent primary hip arthroscopy for treatment of symptomatic labral tears were included. Patient demographic, radiographic, and intraoperative variables were collected. Patients were divided into 2 PEA cohorts: (1) college education or less (CL) and (2) graduate or doctorate education (GD). PRO measures (PROMs) utilized in this study included modified Harris Hip Score (mHHS), International Hip Outcome Tool-33 (iHOT-33), and the Non-Arthritic Hip Score (NAHS). PROs, pain scores, satisfaction rates, revision rates, and THA conversion rates were compared.Results
Overall, 164 patients met inclusion criteria. Both the CL and the GD PEA groups consisted of 82 patients, with mean follow-up of 11.2 ± 2.6 years and 11.1 ± 2.4 years, respectively (P = .34). There were no differences in baseline demographics and radiographic findings between cohorts (P > .05). CL PEA patients resided in more socioeconomically disadvantaged neighborhoods (mean Area Deprivation Index, 23.1 vs 13.9; P < .001) and lived in neighborhoods with worse community-level health literacy estimates (254.4 vs 257.6; P = .03). At minimum 8-year follow-up, GD PEA patients demonstrated higher mean modified Harris Hip Score (mHHS) (89.5 vs 82.8; P = .003) and International Hip Outcome Tool-33 (iHOT-33) (77.5 vs 69.4; P = .04) scores. By multivariate logistic regression, GD PEA patients had greater odds of achieving 10-year Patient Acceptable Symptom State (PASS) for mHHS and the Non-Arthritic Hip Score) compared with CL PEA patients (odds ratio [OR], 3.0; 95% CI, 1.38-6.51; P = .006; OR, 2.4; 95% CI, 1.14-5.22; P = .02). Revision hip arthroscopy and conversion to THA rates were similar between cohorts.Conclusion
Our study demonstrates that GD PEA patients have significantly higher PROs and greater odds of reaching the PASS at minimum 8-year follow-up compared with CL PEA patients. Furthermore, lower PEA is associated with greater socioeconomic disadvantage. The data suggest that orthopaedic surgeons may use education-level data as an important clinical decision-making tool to assess for long-term functional outcomes and secondary surgery rates after hip arthroscopy.
Research Insights
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