Title : Social deprivation and mortality after primary hip and knee arthroplasty: Implications for inequalities in elective orthopaedic care
Abstract:
Aims: To examine whether neighbourhood-level socioeconomic deprivation, measured using the English Index of Multiple Deprivation (IMD), is associated with revision surgery and all-cause mortality after primary Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA).
Methods: This population-based retrospective study used a prospectively maintained regional arthroplasty database. All primary THA and TKA procedures performed between 1 January 2015 and 5 June 2025 were included. Postcode at surgery was used to derive the IMD deciles. Multivariable cause-specific Cox models estimated associations between IMD decile and time to revision, and between IMD decile and time to death, adjusting for age, sex, American Society of Anesthesiologists (ASA) grade and year of surgery. Five-year cumulative revision by IMD quintile was estimated using Kaplan–Meier method and the cumulative incidence function, treating death as a competing event.
Results: 8,144 procedures were analysed, including 8,038 primary arthroplasties and 106 revisions. Of these, 4,219 were THA (52.5%) and 3,819 TKA (47.5%). There were 1,036 deaths and mean follow-up was 5 years. Five?year revision rates were low and similar across IMD quintiles (1.31% Kaplan–Meier, 1.25% cumulative incidence; p≥0.73). In contrast, higher IMD decile (less deprivation) was associated with lower mortality, with a 5% reduction in the hazard of death per decile (all procedures HR 0.95, 95% CI 0.93–0.97; p<0.0001), and similar gradients for THA and TKA.
Conclusion: Neighbourhood-level socioeconomic deprivation was not associated with early- to mid-term revision after primary hip or knee arthroplasty but was independently associated with mortality, supporting deprivation-informed optimisation and follow-up within elective orthopaedic services.
