Rural vs Urban Outcomes in Total Knee and Hip Arthroplasty: A Study of Patient-Reported Outcomes and Web-Based Tool Efficacy.

BACKGROUND

Rural patients in the United States often face higher tobacco use, obesity rates, and lower health literacy, impacting arthroplasty outcomes. This study investigates whether rural residency is directly associated with poorer patient-reported outcomes (PROs) following total knee (TKA) and total hip arthroplasty (THA). It also evaluates the effectiveness of web-based PRO tools across urban and rural populations. Understanding these relationships is crucial for addressing disparities in care and improving surveillance for rural populations.

METHODS

From May 2021 to April 2023, TKA and THA patients at our institution were categorized based on their home zip codes, using the 2020 Census Bureau binary urban-rural classification. Web-based PROs were administered via text or email and assessed using the Knee Injury and Osteoarthritis Outcome Score, Joint Replacement; Hip Injury and Osteoarthritis Outcomes Score, Joint Replacement; University of California, Los Angeles Activity Score; Patient-Reported Outcomes Measurement Information System Global Physical and Mental Health Scores; and Forgotten Joint Scores. PROs were recorded preoperatively and at 6 weeks, 3 months, and 1 year postoperatively. Statistical analysis encompassed chi-square and independent samples t-tests.

RESULTS

Among 781 THA and 1094 TKA cases, survey response rates (71.9%-83.8%) were consistent across urban and rural groups (all P > .05). PROs were similar across all timepoints, except rural THA patients reported lower Patient-Reported Outcomes Measurement Information System Global Physical and Mental Health scores [(Mental:Urban 54.2 ± 8.5 vs Rural 50.7 ± 10.0, P = .021); (Physical: Urban 52.2 ± 8.6 vs Rural 48.9 ± 10.0, P = .029)] at the 1-year postoperative mark.

CONCLUSIONS

Rural patients report comparable arthroplasty-specific PROs following TKA and THA, with a similar response rate to web-based tools.