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Gender and Total Joint Arthroplasty: Variable Outcomes by Procedure Type.

Aalok P Patel1, Christian Gronbeck2, Monique Chambers1

  • 1Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA.

Arthroplasty Today
|August 4, 2020
PubMed
Summary

Gender impacts total joint arthroplasty outcomes differently for hip (THA) and knee (TKA) replacements. Understanding these sex-based differences is crucial for improving patient risk stratification and care after joint surgery.

Keywords:
ArthroplastyGenderHipKneeOutcomes

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Area of Science:

  • Orthopedic Surgery
  • Patient Outcomes Research
  • Gender Disparities in Medicine

Background:

  • Limited data exists on gender's influence on total joint arthroplasty (TJA) outcomes, lacking specific stratification for hip (THA) and knee (TKA) procedures.
  • Previous studies faced limitations due to insufficient longitudinal data or failure to differentiate between THA and TKA outcomes.
  • A clear understanding of gender-specific effects on TJA results remains elusive.

Purpose of the Study:

  • To investigate the influence of gender on patient demographics, comorbidities, operative factors, and short-term outcomes following primary elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).
  • To identify gender-specific risk factors for complications and prolonged length of stay (LOS) after THA and TKA.
  • To provide data for refining risk-stratification models in joint arthroplasty surgery.

Main Methods:

  • Utilized data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for primary elective THAs and TKAs performed between 2011 and 2017.
  • Compared demographic characteristics, comorbidity profiles, operative times, LOS, and 30-day outcomes between male and female patients.
  • Conducted multivariate analyses separately for THA and TKA to identify independent predictors of outcomes.

Main Results:

  • Analyzed 418,885 patients (59.1% female), noting females were older, had higher BMIs, and more functional assistance needs (P < .001).
  • Females exhibited lower rates of certain comorbidities but higher chronic steroid use (P < .001) and shorter operative times (P < .001).
  • Female gender independently predicted higher readmission, reoperation, and wound infection after THA, while male sex predicted these after TKA (P < .001). Females had significantly longer LOS (>2 days) regardless of procedure.

Conclusions:

  • Observed a variable effect of gender on post-arthroplasty LOS and outcomes, contingent on the specific procedure (THA vs. TKA).
  • Emphasized the need to incorporate gender-specific differences into risk-stratification models for joint arthroplasty.
  • Called for future research to explore the underlying etiological factors contributing to observed gender disparities in joint arthroplasty outcomes.