Abstract
Purpose: Medical research has classically been based on the male model, this is no different in the design of arthroplasty implants. Focus has recently shifted to gender-specific implant design but evidence is just developing in the literature as to gender specific outcomes. We hypothesised that outcomes in arthroplasty patients are affected by gender.
Methods: Patients were retrospectively identified from a prospectively collected database of total joint arthroplasties performed at one center. Six surgeons performed 1123 primary unilateral cemented TKA’s, and 989 primary unilateral cementless THA’s over a period of seven years. General demographic data was collected along with preoperative and 1-year clinical outcomes including the Harris Hip/Knee Society Score and Oxford Hip/Knee scores. These were compared to determine differences, if any, between males and females using independent samples t-test.
Results: The TKA sample was comprised of 540 (55%) females and 449 (45%) males. The THA sample included 744 (66%) females and 379 (34%) males.
In the TKA group, females were significantly younger, had higher BMI and had differing rates of comorbidities and complications. Female KSS, Oxford and ROM outcomes were significantly inferior to male scores preoperatively and at 1 year follow up. Significantly more females reported higher pain scores than males from pre-op to 1 year. Interestingly, females showed significantly more improvement from pre-op to 1 year in both scores.
In the THR group there were varying rates of complications and comorbidities by gender. Females did significantly worse in the HHS and Oxford hip score from pre-op until one year when results equalized. Similarly pain scores were higher for females preop and at 6 weeks but became equivalent thereafter. Females showed significantly greater improvements from pre-op to 1 year in both outcome scores.
Conclusion: As reported in the literature, results of this study indicate that women choose TJR at a later stage of disease than men do, presenting with inferior functional status. The effect of waiting seems most marked in the knee arthroplasty population with inferior outcomes and pain relief persisting out to 1 year. Surgeons must counsel females differently about expectations and recovery in joint arthroplasty.
Correspondence should be addressed to ISTA Secretariat, PO Box 6564, Auburn, CA 95604, USA. Tel: 1-916-454-9884, Fax: 1-916-454-9882, Email: ista@pacbell.net
