The failure rates for hip implants are 29% higher for women than they are for men, wrote John Gever, senior editor of MedPage Today. Gever was reporting on a study done by the Southern California Permanente Research Group in San Diego that examined the records of 35, 140 patients and followed them for a mean of three years. The all-case rate of failure, involving subsequent revision surgery, was 2.3% for women and 1.9% for men, reported Maria C.S. Inacio, a member of the research group.
Hip Implant Failure 29% Higher for Women
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Gever wrote that after adjustments were made for age, body mass index, diabetes status, degree of pre-surgical symptom severity, implant fixation method, device category, and femoral head size, the authors calculated a hazard ratio for revision of 1.29% for women versus .95% for men. The researchers reported their conclusions online in JAMA Internal Medicine. The researchers found that the risk appeared most prominent for aseptic revision, compared with septic failure. Other factors leading to implant failure in women were larger femoral head sizes and metal-on-metal implants.
Glever quoted Diana Zuckerman, Ph.D., of the National Research Center for Women and Families in Washington, D.C., who suggested to MedPage Today that the study’s findings were unlikely to influence current practice. “Knowing that their chances of success are lower than men’s is not helpful to women who are unable to perform many activities of daily living, ” she said. What is needed is “long-term comparative effectiveness research based on large sample sizes, indicating which total hip arthroplasty devices are less likely to fail in women and in men, with subgroup analyses based on age and other key patient traits, as well as key surgeon and hospital factors.”
A total of 319 surgeons performed the surgeries at 46 hospitals located in the states of California, Hawaii, Oregon, Washington and Colorado. The data for the study came from the Kaiser Permanente system’s registry of total joint replacements from 2001 to 2010. The registry is the largest of its type in the United States.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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