Men and TKA – The Weaker Sex?

Men who have had a total hip or knee replacement are at a higher risk than are women for suffering a heart attack, infection or revision surgery. The elevated risk was particularly apparent for patients who had total knee arthroplasty (TKA), according to Patrice Wendling, reporting on the research for Rheumatology News Digital Network.

Men had more acute myocardial infarctions (MI) within 90 days of undergoing TKA than did women (1.1% vs. 0.8%), more infection within 2 years of surgery (1.1% vs. 0.7%), and more revision TKA within 2 years (1.5% vs. 1%), reported Gillian Hawker, M.D. professor of medicine at the University of Toronto and physician-in-chief of medicine at Women’s College Hospital, Toronto, who led the study.

Hawker analyzed the records of 97, 445 patients who had elective total joint arthroplasty in Ontario, Canada, between 2002 and 2009. In all, 59, 564 patients (39% male) underwent TKA and 37, 881 patients (46% male) had total hip arthroplasty. The men receiving new knees were similar in age to the women and were less likely to be frail.

The researchers found no sex differences among the TKA patients for venous thromboembolism within 90 days or periprosthetic fracture within 2 years. However, men were at a significantly increased risk for infection and revision TKA within 2 years.

Where hip arthroplasty (THA) was concerned men undergoing total hip replacement had higher rates of early acute MI than women but lower rates of periprosthetic fracture within 2 years. Male patients were younger than their female counterparts.

“We think the potential explanations for acute MI after both hip and knee replacement may be additional cardiovascular risk factors, ” Hawker said. “We did not control for preexisting cardiovascular risk; that is something we are doing now.” The investigators did not find any differences between the sexes in the hip replacement cohort for infection, death, venous thromboembolism, dislocation, or revision.