LAS VEGAS—While women may have their first total joint replacement (TJR) at an older age, they are less likely to have complications related to their surgery or require revision surgery, according to a study presented at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). The findings contradict the theory that TJR is underutilized in female patients because they have worse outcomes than men.
Researchers reviewed patient databases from an Ontario hospital for first-time primary total hip replacement (THR) and total knee replacement (TKR) patients between 2002 and 2009. There were 37,881 THR surgeries (53.8% female) and 59,564 TKR surgeries (60.5% female). Women who underwent THR were significantly older than males (70 years vs. 65 years); however, there was no difference in age between male and female patients undergoing TKR (median age 68 years for both). A greater proportion of female patients undergoing TJR were defined as frail (6.6% vs. 3.5% for THR; and, 6.7% vs. 4% for TKR).
Following surgery, men were:
• 15% more likely to return to the emergency department within 30 days of hospital discharge following either THR or TKR.
• 60% and 70% more likely to have an acute myocardial infarction within 3 months following THR and TKR, respectively.
• 50% more likely to require a revision arthroplasty within 2 years of TKR.
• 25% more likely to be readmitted to the hospital and 70% more likely to experience an infection or revision surgery within 2 years of TKR, compared to women.
“Despite the fact that women have a higher prevalence of advanced hip and knee arthritis, prior research indicates that North American women with arthritis are less likely to receive joint replacement than men,” said lead study author Bheeshma Ravi, MD, PhD, an orthopedic surgery resident at the University of Toronto. “One possible explanation is that women are less often offered or accept surgery because their risk of serious complications following surgery is greater than that of men.
“In this study, we found that while overall rates of serious complications were low for both groups, they were lower for women than for men for both hip and knee replacement, particularly the latter” said Dr. Ravi. “Thus, the previously documented sex difference utilization of TJR cannot be explained by differential risks of complications following surgery.”