Abstract: Background & Objectives: Total hip arthroplasty is one of the most successful and cost-effective treatment for end-stage arthritis. An individual’s socioeconomic status, typically based on income and educational level, occupation and cultural practices has been shown to have an effect on the long term functional outcomes of total hip arthroplasty. Previous studies have shown that patients from a lower socioeconomic class had surgery at a relatively earlier age, had more comorbidities, frequently presented late with severe symptoms and less optimal patient’s satisfaction with surgery. Most of the studies on lower socio economic status and total hip Arthroplasty have been reported from western literature. The purpose of this study was to investigate the functional outcome of total hip arthroplasty and to analyze specific dimensions of total hip arthroplasty in lower socio economic population from Tamil Nadu.
Materials & Methods: we analysed a total of 45 patients [22 females and 23 males] in the age group of 25-70 yrs. with a mean age of 49 years, who had undergone total hip replacement in our hospitals and other private hospitals had been followed up in our hospital due to various reasons including financial constraints for a period of 6 months to 2 years. These people are categorized by modified Kuppusamy classification-2007. Outcome measures used were Harris hip score; visual analogue scale and patient’s level of satisfaction.
Results: There was a significant improvement in Harris hip scores at 6 months compared to pre-operative scores in 50% of patients. Of the forty five patients, five had dislocation, two patients had infection. Seven patients had radio lucent areas in the acetabular zone and femoral zones, three patients had underwent secondary procedures for complications following THR. In our study Nearly 60 % (Twenty Seven in number) of our patients had suffered from complications. Functional outcome of the patients was evaluated using modified Harris hip score, thirteen had excellent outcome, eighteen patients had good and ten had fair outcome, four patients had poorer outcome. The mean pre op Harris hip score was 38 and the post-operative mean Harris hip score was 84. The mean visual analogue scale was improved from pre op score of 9.5 to1.6 post operatively.
Conclusion: Total hip arthroplasty is increasingly done for the patients from lower socio economic status because of state funding and health insurance. There is a relative lack of evidence from Indian literature on the functional outcome of total hip arthroplasty in this sector of people. People with lower socioeconomic status had a greater severity of hip disease with mean Harris hip score of 38 and pre op visual analogue scale of 9.5. Lower income and lesser education contribute to poorer outcome and adverse complications after total hip arthroplasty. We had wide range of complications in 60% of our patients. Persistent pain being the commonest one. Thirty one patients have obtained good to excellent functional outcome and about 30% of patients have not been satisfied after surgery.
By proper health education, thereby creating awareness among them and providing improved access to health care for those with lower income and education, we can decrease the disparity in the outcome in this specific population.
