Effect of Patient-Surgeon Sex Concordance on Total Joint Arthroplasty Outcomes

In fields outside of orthopaedics, patient-physician sex concordance has been linked to improved rapport, better quality of care, and decreased mortality. However, the effects of sex concordance have yet to be evaluated in orthopaedic surgery. This study examined whether patient-surgeon sex concordance was associated with outcomes following total joint arthroplasty (TJA).

This retrospective cohort study used data from a US integrated healthcare system's TJA registry (2009-2020). Patients 18 years and older with hip or knee osteoarthritis who underwent primary total hip or knee arthroplasty were included. The primary outcome was all-cause revision, analyzed using accelerated failure time regression adjusted for potentially confounding variables, with patient-surgeon sex concordance as the exposure. Secondary outcomes included 90-day emergency department (ED) visits and readmissions, analyzed using logistic regression models also adjusted for confounders.

A total of 213,540 patients (median age 67.0 years, 59.9% female, 69.8% White) and 319 surgeons (18 female, 301 male) met the inclusion criteria. There were 70,883 total hip arthroplasty cases and 142,657 total knee arthroplasty cases. Sex concordance was not associated with all-cause revision for male patients (time ratio [TR] 1.18, 95% confidence interval (CI) 0.80-1.75, p = 0.40) or for female patients (TR 0.98, 95% CI 0.72-1.34, p = 0.92). Sex concordance was also not associated with 90-day readmission for male patients (odds ratio [OR] 0.99, 95% CI 0.84-1.16, p = 0.88) or for female patients (OR 0.99, 95% CI 0.86-1.14, p = 0.87). Both male and female patients had a lower likelihood of 90-day ED visit when treated by a female surgeon (OR 0.80, 95% CI 0.71-0.89, p < 0.001 and OR 0.86, 95% CI 0.79-0.94, p < 0.001, respectively).

In this study of 213,540 TJA procedures performed within an integrated healthcare system, surgeon-patient sex concordance was not associated with all-cause revision or 90-day readmission. Ninety-day ED visits were less common among patients treated by female surgeons. Further research is required to determine if there are other aspects of TJA care, such as patient satisfaction or utilization, that could be more affected by patient-surgeon sex concordance.

Therapeutic Level III, prognostic. See Instructions for Authors for a complete description of levels of evidence.