The Association Between Preoperative Education Level and Long-Term Outcomes After Hip Arthroscopy

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: = .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.