Correlation of Sex With Adverse Outcomes Following Total Hip Arthroplasty: A Matched Cohort Analysis

Total hip arthroplasty (THA) is a commonly performed orthopaedic procedure, yet the correlation of patient sex with outcomes has been inadequately explored. Previous studies have been limited by population/database constraints. Thus, 90-day adverse event and 5-year outcome differences were assessed in a large national database.

Patients undergoing THA from the 2010 to 2022 M165 Ortho PearlDiver Mariner Database were identified. Male and female patients were matched 1:1 based on age and Elixhauser Comorbidity Index. Ninety-day adverse events were assessed and compared with multivariable analysis adjusting for multiple comparisons. Five-year survival to revision, dislocation, and periprosthetic fracture was assessed by Kaplan-Meier analysis.

Of 780,745 THA patients, 333,974 (42.7%) were male and 446,771 (57.3%) were female. After matching, there were 327,978 male and 327,978 female patients. At 90 days, female patients had greater odds of any adverse events (odds ratio [OR], 1.36), serious adverse events (OR, 1.76), minor adverse events (OR, 1.43), and readmissions (OR, 1.25; P < 0.001). Female patients had higher rates of surgical site infection, deep vein thrombosis, urinary tract infection, and wound dehiscence but lower rates of cardiac events, pneumonia, and acute kidney injury. At 5 years, female patients had higher rates of revision (1.8% vs. 1.4%, P < 0.001), fracture (1.2% vs. 0.7%, P < 0.001), and dislocation (1.8% vs. 1.2%, P < 0.001).

This study identified notable sex-based differences in THA outcomes. Female patients had greater odds of perioperative complications and 5-year adverse events. These findings may inform patient counseling, surgical planning, and care pathways.