While women may have their first total joint replacement (TJR) at an older age, they are less likely to have complications related to their surgery or require revision surgery, according to a new study presented today at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). The findings contradict the theory that TJR is underutilized in female patients because they have worse outcomes then men.
Total hip (THR) and total knee replacement (TKR) are common surgical treatments for end-stage arthritis, which causes ongoing pain, limited function and diminished life quality.
Researchers reviewed patient databases from an Ontario hospital for first-time primary THR and TKR patients between 2002 and 2009. There were 37,881 THR surgeries (53.8 percent female) and 59,564 TKR surgeries (60.5 percent female). Women who underwent THR were significantly older than males (70 years vs. 65 years); however, there was no difference in age between male and female patients undergoing TKR (median age 68 for both). A greater proportion of female patients undergoing TJR were defined as frail (6.6 percent versus 3.5 percent for THR; and, 6.7 percent versus 4 percent for TKR).
Following surgery, men were:
15 percent more likely to return to the emergency department within 30 days of hospital discharge following either THR or TKR.
60 percent and 70 percent more likely to have an acute myocardial infarction (heart attack) within three months following THR and TKR, respectively.
50 percent more likely to require a revision arthroplasty within two years of TKR.
25 percent more likely to be readmitted to the hospital and 70 percent more likely to experience an infection or revision surgery within two 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,” said lead study author Bheeshma Ravi, MD, PhD, an orthopaedic surgery resident at the University of Toronto. “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.
“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 Dr. Ravi. “Thus, the previously documented sex difference utilization of TJR cannot be explained by differential risks of complications following surgery.”
What is a total knee replacement?
A total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with artificial material. The knee is a hinge joint which provides motion at the point where the thigh meets the lower leg. The thighbone (or femur) abuts the large bone of the lower leg (tibia) at the knee joint. During a total knee replacement, the end of the femur bone is removed and replaced with a metal shell. The end of the lower leg bone (tibia) is also removed and replaced with a channeled plastic piece with a metal stem. Depending on the condition of the kneecap portion of the knee joint, a plastic “button” may also be added under the kneecap surface. The artificial components of a total knee replacement are referred to as the prosthesis.
The posterior cruciate ligament is a tissue that normally stabilizes each side of the knee joint so that the lower leg cannot slide backward in relation to the thighbone. In total knee replacement surgery, this ligament is either retained, sacrificed, or substituted by a polyethylene post. Each of these various designs of total knee replacement has its own particular benefits and risks.
What patients should consider a total knee replacement?
Total knee replacement surgery is considered for patients whose knee joints have been damaged by either progressive arthritis, trauma, or other rare destructive diseases of the joint. The most common reason for knee replacement in the United States is severe osteoarthritis of the knees.
Regardless of the cause of the damage to the joint, the resulting progressively increasing pain and stiffness and decreasing daily function lead the patient to consider total knee replacement. Decisions regarding whether or when to undergo knee replacement surgery are not easy. Patients should understand the risks as well as the benefits before making these decisions.
What are the risks of undergoing a total knee replacement?
Risks of total knee replacement include blood clots in the legs that can travel to the lungs (Pulmonary embolism). Pulmonary embolism can cause shortness of breath, chest pain, and even shock. Other risks include urinary tract infection, nausea and vomiting (usually related to pain medication), chronic knee pain and stiffness, bleeding into the knee joint, nerve damage, blood vessel injury, and infection of the knee which can require reoperation. Furthermore, the risks of anesthesia include potential heart, lung, kidney, and liver damage
Lauren Pearson Riley
American Academy of Orthopaedic Surgeons
2015 AAOS Annual Meeting