Are Patients' Relationships to their Primary Contacts Associated with Postoperative Outcomes after Total Joint Arthroplasty?

Background: Social determinants strongly influence overall health, including recovery after total joint arthroplasty (TJA). The modern electronic health record (EHR) includes a list of individuals identified by patients as their primary contacts. We aimed to assess whether the relationship between patients and their documented primary contacts was associated with outcomes after TJA.

Methods: We retrospectively reviewed primary, elective total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) at a single institution from June 2011 to December 2022 and stratified patients into two groups: Family (F) [familial relationships to include spouse, first/second degree relative] or Non-Family (NF) [non-familial relationships such as friend, neighbor] based on patient relationship to their primary emergency contact. Baseline characteristics and postoperative outcomes were compared. Binary logistic regression was utilized to assess variables associated with all-cause revision. In total, 17,520 THAs were included: 16,123 (92.0%) in the F group and 1,397 (8.0%) in the NF group. Additionally, 20,397 TKAs were included: 18,819 (92.3%) in the F group and 1,578 (7.7%) in the NF group.

Results: For both THA and TKA patients, having a NF primary contact was independently associated with a higher risk of all-cause revision at the latest follow-up (OR [odds ratio]: 1.48 [95% CI (confidence interval): 1.05 to 2.08], P = 0.025) and (OR: 1.62 [95% CI: 1.10 to 2.38], P = 0.014), respectively. In both THA and TKA, the F group had shorter lengths of stay (P < 0.001) and was more likely to be discharged home (P < 0.001) compared to the NF group.

Conclusion: Total joint arthroplasty patients who have a familial primary contact demonstrate better postoperative outcomes compared to those who do not have a familial contact. Awareness of social support and additional postoperative support for patients who have NF primary contacts may be warranted following TJA.