In the first 30 days after total hip arthroplasty (THA) or total knee arthroplasty (TKA), does it matter if you are female or male? That’s what researchers from the Icahn School of Medicine at Mount Sinai in New York wanted to know. According to the authors, Jonathan Robinson, M.D., John I. Shin, B.S., James Dowdell, M.D., Calin S. Moucha, M.D., Darwin D. Chen, M.D., the impact of gender on 30-day complications has been studied in other procedures but not yet in THA or TKA.
Influence of Gender on Outcomes After THA, TKA
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THA patients consisted of 45.1% male and 54.9% female. TKA patients consisted of 36.7% male and 62.3% female.
Darwin Chen, M.D. is assistant professor, orthopedics, at the Icahn School of Medicine. He told OTW, “Total hip and knee replacement surgery are among the most commonly performed orthopedic procedures today. Although success rates are high, complications can occur and some may be preventable. The goal of our research was to assess the impact of gender on complications within the first 30 days after hip and knee replacement.”
“We looked at a large national database (NSQIP-National Surgical Quality Improvement Program) and assessed 54,502 patients undergoing THA and 87,177 patients undergoing TKA. After both hip and knee replacement, female gender was found to be protective of mortality, sepsis, cardiovascular events, unplanned reintubation, and renal complications. Female gender was an independent risk factor for urinary tract infections, needing a blood transfusion, and discharge to a rehabilitation facility.”
“Males and females have different postoperative risks for unclear reasons. Some theories include differences in preoperative hemoglobin levels, home support systems, pain tolerance, and other comorbid medical conditions.”
“The postsurgical risks after hip and knee replacement are different between men and women. When we counsel our patients before surgery, gender should play a role in the discussion.”
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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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