Original Article
The Clinical Effect of Gender on Outcome of Total Knee Arthroplasty

https://doi.org/10.1016/j.arth.2007.10.031Get rights and content

Abstract

The purpose of this study was to quantify the effect of sex on the clinical outcome and survivorship of a total knee arthroplasty (TKA) with clinical and radiographic follow-up. Seven thousand three hundred twenty-six primary AGC (Biomet, Warsaw, Ind) cruciate-retaining TKAs were performed from 1987 to 2004. Of these, 59.5% were performed on women. We examined preoperative and postoperative Knee Society knee score, function scores, pain scores, walking ability, stair-climbing ability, flexion, and implant survivorship based on sex. Female sex was associated with lower overall preoperative clinical scores for all parameters (P < .01). Improvement in Knee Society knee score and flexion was greater for women (P = .006), and there were equal pain relief and walking improvements for both sexes (P < .32). Stair and function score improvements were greater for men (P = .002). Implant survival was 98% for women and men at 15 years (P = .4684). We conclude that improvement after TKA is similar for men and women, with few clinically significant differences. Sex-specific implants would appear to offer no clinical advantage.

Section snippets

Materials and Methods

Between April 1987 and May 2004, 7890 primary TKAs were performed at our institution for the treatment of osteoarthritis with a posterior cruciate-retaining TKA (AGC; Biomet, Warsaw, Ind) independent of diagnosis or deformity and based on surgeon preference. Data were unavailable in 564 (6.7%) knees, which were considered lost to follow-up, leaving 7326 TKAs followed for this study. Of the patients, 59.5% were women. The mean age was 69.2 years (range, 24-93 years) (Table 1). The institutional

Results

Preoperative KSS was greater in men (P = .0014). No sex differences in KSS were noted postoperatively at any follow-up (Fig. 1). Women, however, experienced a greater improvement in KSS after TKA (P = .0066).

Preoperative PS was also greater (less pain) in men (P = .0005). Postoperatively, men also had consistently higher PS (P < .0001). The change in PS before and after TKA was not statistically different (Fig. 2).

Similarly, FS was greater in men before operation (P < .0001). Throughout the

Discussion

Most TKAs are performed in women [1], [11], [12] as demonstrated in this study, in which 59.5% of the TKAs were performed in women. The ratio between the anterior-posterior and medial-lateral dimensions of the distal femur as measured from its distal portion is often different between men and women [2], [3], [5], [6], [7]. In a study by Hitt et al [3], many current femoral TKA prostheses were evaluated using the dimensions of these prostheses compared with anatomical measurements of knees

References (13)

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