The Impact of Patient Travel Time and Rurality on Outcomes After Total Joint Arthroplasty

Abstract

Patients undergoing total joint arthroplasty (TJA) often face geographically driven barriers to preoperative, perioperative, and postoperative care. Using data from the multicenter PEPPER Trial (≈9,000 patients), this study investigates whether travel time to clinical sites and rural residence influence patient-reported outcomes—including HOOS, KOOS, PROMIS scores—and adverse events following total hip or knee arthroplasty. Travel time was calculated using GIS-based estimations between patient home zip codes and clinical sites, while rurality was defined via RUCA classifications. The study hypothesizes that patients with longer travel times or rural residence may experience delayed follow-up, reduced access to postoperative care, and poorer functional recovery. Planned analyses will evaluate changes in functional scores at 1, 3, and 6 months post-surgery, as well as correlations with emergent and non-emergent adverse events. With rural patients disproportionately affected by transportation, cost, and resource limitations, this work aims to clarify how geographic inequities influence recovery trajectories and to inform targeted care models that support postoperative rehabilitation for geographically isolated populations.