Socioeconomic Status Is Associated With the Risk of Girdlestone Resection Arthroplasty After Periprosthetic Infection of the Hip

Introduction:Girdlestone resection arthroplasty (GRA) is a radical but sometimes necessary treatment of periprosthetic joint infection (PJI) of the hip. The purpose of this of this study was to identify the independent risk factors for GRA after PJI of the hip.Methods:This is a retrospective, cross-sectional analysis of the National (Nationwide) Inpatient Sample from 2010 to 2014. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) was used to identify 27,404 patients with PJI of the hip, including 889 patients who underwent GRA (ICD-9-CM 80.05). A multivariate model was created to examine the association between GRA and patient characteristics such as age, sex, race, primary payer, median household income, and location and teaching status of the hospital where the procedure was performed. Furthermore, the model controlled for patient comorbidities, including diabetes, anemias, hypertension, congestive heart failure, chronic pulmonary disease, peripheral vascular disease, and drug abuse.Results:The strongest independent risk factor for GRA was Medicare insurance (odds ratio [OR], 1.859, 95% confidence interval [CI], 1.500 to 2.304). Medicaid insurance was also associated with GRA (OR, 1.662, CI, 1.243 to 2.223). Compared with the wealthiest quartile for household income, patients in the poorest quartile (OR, 1.299, CI, 1.046 to 1.614) and second poorest quartile (OR, 1.269, CI, 1.027 to 1.567) were significantly more likely to have a GRA. Furthermore, patients older than 80 years old were at a higher risk of GRA than all other age groups (P < 0.05). No statistical differences were seen regarding patient race or sex.Conclusions:This study demonstrates that poorer patients, patients with government health insurance plans, and elderly patients are each at independently heightened risk of undergoing a GRA for the treatment of PJI of the hip.Level of Evidence:III, retrospective cohort study.