S. Ismael (Chester, GB)

RJAH Hospital Orthopaedics

Presenter Of 1 Presentation

Podium Presentation Clinical Outcome

18.1.5 - Socioeconomic Area Deprivation is Related to a Poorer Patient-Reported Outcome following Autologous Chondrocyte Implantation (ACI)

Presentation Topic
Clinical Outcome
Date
14.04.2022
Lecture Time
14:51 - 15:00
Room
Bellevue
Session Type
Free Papers
Disclosure
No Significant Commercial Relationship

Abstract

Purpose

Autologous chondrocyte implantation (ACI) is an effective treatment for isolated knee chondral defects. Increasing evidence highlights the impact of socioeconomic deprivation on the outcome of orthopaedic surgery. This study aimed to determine the association between socioeconomic deprivation and short-term patient-reported ACI outcomes.

Methods and Materials

All patients at our institution who underwent knee ACI between 1996-2020 were identified. Socioeconomic deprivation of their residential area was quantified by the Index of Multiple Deprivation (IMD) and employment/income deprivation. One-year Lysholm scores were the primary outcome. After transformation where needed to ensure normal distributions, linear multivariable regression was used to analyse the relation between IMD and 1-year Lysholm score, adjusting for demographic characteristics (age, sex, BMI and smoking) and baseline Lysholm.

Results

We identified 391 patients with mean age 50 years (range 16-84; 266 (68%) male). BMI and deprivation were log-transformed to achieve normal distributions. Median BMI was 27 (17-47): 138 patients (43%) were overweight and 105 (33%) obese. Seventy-seven patients lived in upper and 41 in lower quintile deprivation areas. The mean baseline Lysholm score was 49.8±17.3SD, improving to 66.5±21.3SD at 1 year. Mean one-year Lysholm scores were significantly lower with increasing area deprivation scores, adjusted for demographic factors (Table 1). Specifically, areas with high unemployment levels were associated with poorer functional outcomes (Table 1). Being female or having a lower baseline Lysholm was also associated with poorer outcomes, but age, BMI, smoking or higher income deprivation were not.

table 3 aci study.jpg

Conclusion

This study demonstrates poorer functional outcomes following ACI in patients from more deprived areas. Specifically higher unemployment levels were associated with lower mean 1-year Lysholm scores, as were female gender. Future studies in patients undergoing ACI should consider neighbourhood deprivation as a confounding factor. Further, targeting patients from areas with higher deprivation with special interventions may improve their outcomes.

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