There is a growing requirement by governmental and other funders of research, that investigators pay attention to and integrate considerations of sex and gender in their health research studies. Doing so, the argument goes, will reduce data waste, lead to the generation of more complete and accurate evidence to apply to the delivery of health care, and hopefully improve outcomes for both male and female patients. Yet, it is not always clear what sex and gender mean and how best to apply these to the study of diverse health conditions and health service delivery. In this presentation sex, gender and other related factors will be considered in the context of fractures, fracture repair, and post-operative management. Examples of sex and gender bias, sex and gender differences, and the integration of sex and gender in research on fracture and fracture repair will be presented

We need to shift our focus to integrating sex and gender into research proposals, so we can answer some of the most basic unanswered questions in the field of fracture management. Current evidence in guidelines indicate a near-to-linear increase from the 1990s for inclusion of sex and gender. However, these recommendations remain expressed in absolute terms, with little explanatory power, affecting uptake and implementation in clinical practice. This co-branded session, with members of the Orthopaedic Research Society – International section of fracture repair (ORS-ISFR), will provide participants with guiding principles and tools to assist researchers and grant reviewers understand what it means to include sex and gender in meaningful ways: from formulating research questions, recruitment strategies, to conducting sex-stratified analyses. In this presentation, we will consider diverse approaches, methods and, analyses to elevate sex and gender within trauma. A strong emphasis on the ways and means of including marginalized and vulnerable populations in research will be addressed

The presentation of musculoskeletal disease differs in men and women, and recognition of the differences between men and women's burden of disease and response to treatment is critical to optimizing care. In this presentation, I will discuss the expanding evidence in the literature that examine the role of sex and gender in musculoskeletal disease, including how its examination increases the innovations and contributions, as well as expands the knowledge about musculoskeletal disease, conditions, and injury in a broad sense. We will discuss the role that structural anatomy differences, hormones, and genetics play in differential disease expression, to the historical biases in the subject populations of clinical and basic research projects. Participants will be provided with examples and opportunities to evaluate orthopaedic science through a sex and gender lens, and what impact this may play in setting the stage for both clinical practice and scientific investigation

To our knowledge in medial unicompartmental knee arthroplasty (UKA) no study has specifically assessed the difference in outcome between matched gender groups. Previous unmatched gender studies have indicated more favourable results for women. Method. 2 groups of 40 of either sex was determined sufficient power for significant difference. These consecutively were matched with both the pre-operative clinical and radiological findings. Minimum follow up of 2 years, mean follow-up 5.9 years. Mean age at operation was 71 years. Results. In both groups, the mean IKS knee and function scores improved significantly (p< 0.001) post operatively. There were no significant differences were between the 2 groups. In both groups mean preoperative flexion was 130 degrees and remained unchanged at final follow-up. No significant differences in preoperative and postoperative axial alignment and in the number of radiolucent lines, between groups. With component size used there was a significant difference (p < 0.001) between the 2 groups. However the size of the femoral or tibial implant used was significantly related (p< 0.001) to patient height for both sexes. Radiolucent lines were more frequent on the tibial component, but were considered stable with none progressing. No revisions for component failure. 1 patient in each group developed lateral compartment degenerative change. Male group; one conversion to TKA for undiagnosed pain, three patients underwent reoperation without changing the implant. Female group; no implants were revised, and two patients required a reoperation. Kaplan-Meier 5-year survival rate of 93.46% (84.8; 100) for men and100% for women. The survival rate difference is not significant (p=0.28). Conclusion. These results suggest that there is no difference in outcome between sexes and that gender should not enter into the selection criteria for UKA. It also suggests that height and not gender is important to predict the appropriate UKA components

We compared the length of hospitalisation, rate of infection, dislocation of the hip and revision, and mortality following primary hip and knee arthroplasty for osteoarthritis in patients with Alzheimer’s disease (n = 1064) and a matched control group (n = 3192). The data were collected from nationwide Finnish health registers. Patients with Alzheimer’s disease had a longer peri-operative hospitalisation (median 13 days vs eight days, p < 0.001) and an increased risk for hip revision with a hazard ratio (HR) of 1.76 (95% confidence interval (CI) 1.03 to 3.00). Dislocation was the leading indication for revision. There was no difference in the rates of infection, dislocation of the hip, knee revision and short-term mortality. In long-term follow-up, patients with Alzheimer’s disease had a higher mortality (HR 1.43; 95% CI 1.22 to 1.70), and only one third survived ten years post-operatively. Increased age and comorbidity were associated with longer peri-operative hospitalisation in patients with Alzheimer’s disease.

Cite this article: Bone Joint J 2015;97-B:654–61.