Homelessness is a major social predictor of health, with a patient population of about 580,000. Total Joint Arthroplasty (TJA) is a successful treatment for symptomatic end-stage osteoarthritis of the hip and knee, and it has been demonstrated to enhance health-related quality of life in the general population. However, there is a scarcity of research on the results of TJA in homeless patients.
For a study, researchers analyzed 442 patients who received primary, unilateral TJA at an urban, tertiary, academic safety-net hospital between June 1, 2016, and August 31, 2017. They categorized 28 homeless patients and 414 nonhomeless patients based on self-reported living status. Fisher exact tests, Student t-tests, and multivariate logistic regression were used to compare the two groups’ demographics, preoperative conditions, and surgical results.
The homeless were younger, more typically male, smokers with an alcohol use problem, and users of illegal substances. After controlling for age, gender, and preoperative medical and social conditions, homeless patients were 15.83 times more likely than non-homeless patients to visit the emergency department within 90 days (adjusted odds ratio, 15.83; 95% CI, 5.05 to 49.59; P<0.0001), but had similar rates of readmission (P=0.25), revision surgery (P=0.38), and prosthetic joint infection (P=0.25). Although homeless patients did not have a greater likelihood of readmission or revision surgery, they still present distinct issues for TJA patients and physicians. TJA may offset the risk of poor results for these patients with appropriate preoperative optimization and collaborative assistance.