Will gender-specific total knee arthroplasty be a better choice for women? A systematic review and meta-analysis

The aim of this meta-analysis was to review published articles that compared gender-specific total knee arthroplasty (TKA) with conventional TKA for short- or long-term outcomes and to determine which implant leads to a better outcome.

A systematical electronic search was conducted in the database of PubMed, Embase, and the Cochrane Library for prospective and retrospective trials. Two investigators independently reviewed articles, and another two authors extracted information from the included studies. The assessment of methodological quality of eligible studies was performed by using the Cochrane collaboration's tool for assessing risk of bias. Meta-analysis was performed for the outcomes of clinical outcomes including knee society score (KSS), range of motion (ROM), deep infection, overhang of prosthesis, postoperative pain, reoperation rate, and radiolucent line.

Five RCTs and one retrospective study with 1,120 TKAs in 717 patients met the inclusion criteria. Gender-specific TKA and conventional TKA could significantly increase ROM and KSS scores postoperatively, but no difference was observed between two groups. In addition, there was no statistical difference between these two implants in terms of deep infection (OR = 0.97, 95% CI 0.19-4.82, p = 0.97), postoperative pain (OR = 1.05, 95% CI 0.68-1.61, p = 0.83), reoperation rate (OR = 0.78, 95% CI 0.21-2.93, p = 0.71), and radiolucent line (OR = 0.96, 95% CI 0.46-2.01, p = 0.91). However, gender-specific TKA significantly reduced the number of patients with overhang of femoral component in comparison with conventional TKA (OR = 0.04, 95% CI 0.00-0.27, p = 0.001).

Despite a lower overhang rate, there was insufficient evidence in favor of gender-specific TKA with regards to KSS score, ROM, deep infection, postoperative pain, reoperation rate, and radiolucent line.