Far Fewer Complications

Women afraid of having total hip or knee replacement surgery can take heart from a study released today at the 2015 annual meeting of the American Academy of Orthopaedic Surgeons.

It turns out that despite the fact that men are reputed to do better following such surgery, the study, led by Dr. Bheeshma Ravi, concluded the opposite is actually true.

Ravi, an orthopedic surgery resident at the University of Toronto, wondered if women — who have a higher prevalence of advanced hip and knee arthritis than men — were less likely to be referred by their doctors for surgery because of the fear of postoperative complications.


So Ravi decided to review patient databases from an Ontario hospital for first-time primary knee and hip replacement patients between 2002 and 2009. Such surgery is a common treatment for end-stage arthritis, which can cause ongoing pain, limited function, and a reduced quality of life.

While women tend to have their first total joint replacement at an older age, they are less likely to have complications related to their surgery or require revision surgery, according to Ravi. He noted that women were “more focused” before surgery, asking more questions about possible complications.

If there is a bias against women having joint replacement, Ravi said, it’s clearly not based on post-op complications. He emphasized that the rate of complications was quite low for both genders.

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“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 Ravi. “Thus, the previously documented sex difference utilization of [total joint replacement] cannot be explained by differential risks of complications following surgery.”

Ravi urged patients, regardless of gender, to have a frank discussion with their physician and surgeon to discuss the risks and benefits of these surgeries.

“The vast majority of patients can expect a good result in terms of less pain and better quality of life,” he said.

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Tens of Thousands of Cases Studied

In the study group, there were 37,881 hip replacement surgeries, of which almost 54 percent were women. There were also 59,564 knee surgeries, with 60 percent women.

Women who underwent the hip procedure were older than the men (70 years versus 65 years). There was no difference in age between male and female patients undergoing knee surgery (median age 68 for both).

An additional factor was the percentage of female patients classified as frail. For hip surgery, 6.6 percent of women were designated as frail, compared to 3.5 percent of the males. For the knee operation, it was 6.7 percent women versus 4 percent for the men.

After surgery, the gender differences became more pronounced. Following either procedure, men were 15 percent more likely to return to the emergency department within 30 days of hospital discharge.

Men were also 60 percent more likely to have a heart attack within three months following hip surgery. They were 70 percent more likely following a knee operation.

And within two years after the knee procedure, men were 50 percent more likely to require a revision arthroplasty, 25 percent more likely to be readmitted to the hospital, and 70 percent more likely to experience an infection or revision surgery.

Now that he’s studied the numbers, Ravi is curious about how the statistics stack up against patient perceptions. So there might be another study examining patients’ feelings about levels of pain, functionality, and quality of life following joint replacement surgery.

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