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March 26, 2015

Women fare better than men following total knee, hip replacement

While still relatively rare, men face higher rates of complications and need for revision surgery

LAS VEGAS - While women may have their first total joint replacement (TJR) at an older age, they are less likely to have complications related to their surgery or require revision surgery, according to a new study presented today at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). The findings contradict the theory that TJR is underutilized in female patients because they have worse outcomes then men.

Total hip (THR) and total knee replacement (TKR) are common surgical treatments for end-stage arthritis, which causes ongoing pain, limited function and diminished life quality.

Researchers reviewed patient databases from an Ontario hospital for first-time primary THR and TKR patients between 2002 and 2009. There were 37,881 THR surgeries (53.8 percent female) and 59,564 TKR surgeries (60.5 percent female). Women who underwent THR were significantly older than males (70 years vs. 65 years); however, there was no difference in age between male and female patients undergoing TKR (median age 68 for both). A greater proportion of female patients undergoing TJR were defined as frail (6.6 percent versus 3.5 percent for THR; and, 6.7 percent versus 4 percent for TKR).    
Following surgery, men were:
  • 15 percent more likely to return to the emergency department within 30 days of hospital discharge following either THR or TKR.
  • 60 percent and 70 percent more likely to have an acute myocardial infarction (heart attack) within three months following THR and TKR, respectively.
  • 50 percent more likely to require a revision arthroplasty within two years of TKR.
  • 25 percent more likely to be readmitted to the hospital and 70 percent more likely to experience an infection or revision surgery within two years of TKR, compared to women.
“Despite the fact that women have a higher prevalence of advanced hip and knee arthritis, prior research indicates that North American women with arthritis are less likely to receive joint replacement than men,” said lead study author Bheeshma Ravi, MD, PhD, an orthopaedic surgery resident at the University of Toronto. “One possible explanation is that women are less often offered or accept surgery because their risk of serious complications following surgery is greater than that of men.
“In this study, we found that while overall rates of serious complications were low for both groups, they were lower for women than for men for both hip and knee replacement, particularly the latter” said Dr. Ravi. “Thus, the previously documented sex difference utilization of TJR cannot be explained by differential risks of complications following surgery.” 
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Study abstract
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