Sex and Gender-Related Differences in the Outcome of Total Hip Arthroplasty: A Current Concepts Review (original) (raw)
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Gender Differences for Hip and Knee Arthroplasty: Complications and Healthcare Utilization
The Journal of Arthroplasty, 2019
Introduction: The influence of patient gender on complications and healthcare utilization remains unexplored. The purpose of the present study was to determine if patient gender significantly affected outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods: Retrospective cohort study of THA and TKA patients was performed using the Nationwide Inpatient Sample from 2002 to 2011. Only patients who underwent elective procedures and those with complete perioperative data were included. Multivariate logistic regression was used to compare the rates of adverse events between male and female cohorts while controlling for baseline characteristics. Results: A total of 6,123,637 patients were included in the study (31.2% THA and 68.8% TKA). The cohort was 61.1% female. While males had a lower rate of any adverse event (odds ratio [OR] ¼ 0.8, P < .001), urinary tract infection (OR ¼ 0.4, P < .001), deep vein thrombosis/pulmonary embolism (OR ¼ 0.9, P < .001), and blood transfusion (OR ¼ 0.5, P < .001), male gender was associated with statistically significant increases in the rates of death (OR ¼ 1.6, P < .001), acute kidney injury (OR ¼ 1.6, P < .001), cardiac arrest (OR ¼ 1.7, P < .001), myocardial infarction (OR ¼ 1.6, P < .001), pneumonia (OR ¼ 1.1, P < .001), sepsis (OR ¼ 1.6, P < .001), surgical site infection (OR ¼ 1.4, P < .001), and wound dehiscence (OR ¼ 1.4, P < .001). Conclusion: Males had increased rates of many individual adverse events. Females had higher rates of urinary tract infection, which translated to an overall higher rate of adverse events in females because of the rarity of the other individual adverse events.
Acta Orthopaedica
Background and purpose: The sex of the surgeon has been proposed to be associated with a disparity in clinical outcomes after different surgical procedures. We investigated the association between surgeon–patient sex discordance and adverse events (AEs) and surgical AEs (SAEs) within 90 days after primary total hip arthroplasty (THA). We also investigated patient-reported satisfaction with surgical outcomes 1 year after the surgery.Patients and methods: We conducted a register-based cohort study including primary THAs performed due to osteoarthritis between 2008 and 2016 at 10 publicly managed hospitals in western Sweden. Hospital data was linked to the Swedish Arthroplasty Register and a regional patient register. Logistic regression models investigated discordant sex of patients and surgeons on AEs/SAEs and patient-reported satisfaction with the surgical outcome.Results: 11,993 primary THAs were included in the study. The proportion of AEs for the concordant group was 7.3% and for...
The Journal of Arthroplasty, 2016
Background: Women present later than men for total knee arthroplasty (TKA) with more severe osteoarthritic disease but achieve comparable functional improvement and implant survival and also lower rates of revision. Despite these findings, there is significant underutilization of the procedure for women compared to men. Methods: We conducted a retrospective study to address the lack of information in the literature concerning the immediate and short-term perioperative outcomes between genders. The National Hospital Discharge Survey was evaluated between 2001 and 2010 for men and women undergoing primary TKA in the United States. Differences in gender, patient demographics, comorbidities, complications, length of stay, and discharge disposition were analyzed and identified. Results: The growth in TKA was 145% for men and 131% for women over the 10-year period. Women presented with significantly higher rates of obesity, morbid obesity, postoperative transfusion rate, and length of stay. In contrast, men showed a greater proportion of diabetes, postoperative wound infections, and increased mortality rates. Males were also more likely to be discharged to home, whereas females were more likely to be discharged to rehabilitation facilities. Conclusion: Our findings provide important insight into the perioperative outcomes that may be influencing gender disparity in TKA.
Sex effects on short-term complications after hip fracture: a prospective cohort study
Clinical Interventions in Aging, 2015
Objectives: To evaluate potential sex differences and other factors associated with complications within 4 months after a hip fracture. Methods: A total of 1,915 patients 65 years (480 men) with hip fracture were consecutively included in a prospective multicenter cohort study. A review of medical records and patient interviews according to a study protocol based on the Standardized Audit of Hip Fractures in Europe (SAHFE, RIKSHÖFT) was performed. Sex differences in comorbidity according to the American Society of Anesthesiologists score and complications 4 months after a hip fracture were registered. Multivariate logistic regression analysis was performed to identify factors related to complications. Results: Male sex was associated with worse general health according to the American Society of Anesthesiologists classification (P=0.005) and with more comorbidities (P0.001). Male sex emerged as a risk factor for developing pneumonia (P0.001), and additionally, 18% of the men suffered from cardiac complications compared with 13% of the females (P=0.018). Female sex was predisposed for urinary tract infections, 30% vs 23% in males (P=0.001). Mortality was higher in the male vs female group, both within 30 days (15% vs 10%, P=0.001) and at 4 months (24% vs 14%, P=0.001). Conditions associated with pneumonia were male sex, pulmonary disease, and cognitive impairment. Cardiac complications were associated with delayed surgery and cardiovascular and pulmonary disease. Conclusion: Before surgery, men with hip fracture already have a poorer health status and higher comorbidity rate than women, thus resulting in a twofold increased risk of pneumonia. Cognitive dysfunction and pulmonary disease contributed to pneumonia in men. Delayed surgery seems to increase the risk for cardiac complications. It is important to consider the sex perspective early on together with cardiopulmonary comorbidity and cognitive dysfunction to be able to counteract serious complications that may lead to death.
Examining Sex and Gender Disparities in Total Joint Arthroplasty
Clinical Orthopaedics and Related Research®, 2011
Background Total joint arthroplasty (TJA) is remarkably successful for treating osteoarthritis: most patients see substantial gains in function. However, there are considerable geographic, racial, and gender variations in the utilization of these procedures. The reasons for these differences are complex. Questions/purposes We examined sex and gender disparities in TJA. Methods Through Medline/PubMed searches, we identified 632 articles and from these selected 61 for our review. Where are we now? A number of factors might explain sex and gender disparities in TJA: underrepresentation in clinical trials, differences in willingness to undergo surgery, pain responses to underlying disease and treatment, patient-physician relationships, treatment preferences, provider-level factors such as physician-patient communication style, and system-level factors such as access to specialist care. Since women have a higher prevalence of arthritis and degenerative joint diseases and overall demand for these procedures will continue to grow, the need to understand why there is a gap in utilization based on gender is imperative. Where do we need to go? Understanding what exactly is meant by ''disparity'' is essential because it is possible anatomic factors may have different impacts on utilization from cultural factors. Ideally, information about these factors should be integrated into the decision-making process so that patients and providers can make the most informed choice about whether or not to undergo the procedure. How do we get there? To better understand all of the potential reasons for how anatomic and cultural factors related to sex and gender might impact decision-making and overall utilization of TJA, more research focusing on these factors must be designed and carried out.
Demographic biases found in scoring instruments of total hip arthroplasty
The Journal of Arthroplasty, 1996
Four hip scoring systems were used in evaluating 200 adult subjects who had no prior history of injury, pathologic condition, or treatment of the hips, knees, lower extremities, or spine. All subjects were in the age range typical of a total hip arthroplasty candidate (average age, 65 years; range, 50-100 years). In addition to a physical examination, complete demographic data were collected on each subject. Data were recorded on standardized flow sheets so that hip scores could be calculated; scores were normalized by dividing the observed scores by the maximum possible score. The average normalized total hip scores were Harris hip score, 90.8%; modified Harris hip score, 91.9%; Merle D'Aubigne score, 93.9%; and Hospital for Special Surgery hip rating, 87.5%. Demographic variables that had a significant negative correlation with hip scores included advanced age (particularly past age 85), an income below the poverty level, and the presence of two or more major medical conditions. Differences in hip scores between different study groups that have not been matched for various clinically relevant factors ("case mix") are at least as likely to represent differences in the patient populations as differences in surgical technique or implant design. Hip scores may decline over the course of a I0-to 20-year follow-up period due to the change in a patient's age and/or medical condition rather than any factor relating to the hip arthroplasty. Key words: hip scoring system, total hip arthroplasty, demographics biases.