Hip and Knee Replacement in Safety-net Hospitals: Recognizing the Challenges

Factors endemic in safety-net hospitals may breed poor outcomes in hip and knee arthroplasty. This review highlights these challenges and discusses strategies to reduce operative risk and promote better surgical outcomes. Sub-optimally managed medical co-morbidities, poverty, and substance abuse are examples of challenges common in safety-net hospital populations and are associated with poor surgical outcomes. Patient management strategies that positively affect surgical outcomes may be nonexistent, underfunded, or underused. Surgical complications frequently lead to reoperations, particularly revision arthroplasty. Revision procedures are costly, in terms of patient morbidity and financial expenditure. Safety-net institutions can ill afford the burden of caring for preventable complications following arthroplasty procedures. Prospective studies are needed to define the status of arthroplasty care and patient outcomes in U.S. safety-net hospitals. Best practices that have been shown in non-safety-net hospitals to improve outcomes may prove beneficial in safety-net hospitals.