Total Joint Replacement More Problematic for Men
At least four key quality measures reveal that men are more greatly affected by complications associated with total joint replacement than women. The findings reverse common thinking that women undergo the procedure less frequently than men because women experienced worse outcomes.
The measures were part of a presentation offered by Bheeshma Ravi, MD, PhD, at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). Ravi is an orthopaedic surgery resident at the University of Toronto.
According to a media release from the AAOS that reviewed Ravi’s presentation, researchers evaluated patient statistics from 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 versus 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% compared to 3.5% for THR; and, 6.7% versus 4% for TKR).
Key findings provided by the study analysis showed males are 15% more likely to return to the emergency department within 30 days of hospital discharge after THR or TKR, and that they are 60% and 70% more likely to have an acute myocardial infarction within 3 months of THR and TKR respectively.
Furthermore, the analysis reveals, men are 50% more likely to require a revision arthroplasty within 3 years of TKR, and 25% more likely to be readmitted to the hospital. Men were also found to be 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,” Ravi says. “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.”
Ravi points out that this determined that while overall rates of serious complications are low for both groups, they are lower for women for both hip and knee replacement. “Thus, the previously documented sex difference utilization of TJR cannot be explained by differential risks of complications following surgery,” Ravi adds.