Do We Need Gender-specific Total Joint Arthroplasty?

Background The contralateral femur frequently is used for preoperative templating for THA or hemiarthroplasty when the proximal femur is deformed by degenerative changes or fracture. Although femoral symmetry is assumed in these situations, it is unclear to what degree the contralateral femur is symmetrical. Questions/purpose We therefore defined the degree of asymmetry between left and right proximal femurs and determined whether it was affected by demographics and proximal femoral anatomy. Methods We obtained 160 paired femurs from individuals (20-40 years old), evenly distributed for gender and ethnicity (African-American and Caucasian). The height and weight of the individuals were recorded. We measured the femoral head diameter, minimal femoral neck diameter in the AP and cephalocaudal (CC) planes, and the AP femoral diaphyseal diameter. The absolute and percent differences were determined.Results All femoral measurements showed an absolute difference less than 2 mm and a percent asymmetry and difference less than 2% for the femoral head, less than 4% for the femoral neck, and less than 3.5% for the femoral shaft. We found no correlation or predictive value between absolute differences and asymmetry and age, ethnicity, gender, or weight. Height was negatively associated with femoral head differences and thus increased symmetry of the femoral head. Conclusions Our data support assumptions of substantial symmetry of the proximal femur and highlights that asymmetry is not affected by demographics or the size of the proximal femur. Asymmetry tends not to occur in isolated segments of the femur.

Section: Discussionmentioning

confidence: 96%

Are the Left and Right Proximal Femurs Symmetric?

Young

Gebhart

Cooperman

et al. 2013

“…The need for new strategies for optimizing outcomes for all patients after TKA is discussed. The role of an implant specifically designed for women is addressed in a different article in this symposium [12].…”

Section: Introductionmentioning

confidence: 99%

Implant Survival, Knee Function, and Pain Relief After TKA: Are There Differences Between Men and Women?

O’Connor

2011

Background As efforts continue to improve the results of TKA, the potential influence of sex and gender on longterm survival of implants, knee function, pain relief, and patient satisfaction remains relevant, particularly given the increased incidence of osteoarthritis of the knee in women and reports that women derive equal benefit from TKA. Questions/purposes This article reviews the literature pertinent to the question of whether long-term survival, knee function, pain relief, and patient satisfaction after TKA differ between men and women. Methods Large clinical series ([ 1000 patients) published in the last 10 years were identified in PubMed and reviewed. Results Men may be at higher risk of revision surgery than women. Sex/gender has been consistently shown to impact both function and pain relief both before and after TKA. Although women achieve at least the same degree of functional improvement as men, women have worse preoperative physical function and do not reach the same final level of physical function as men. Likewise women may have similar or even greater improvement in pain after arthroplasty than men but still have final pain scores that are less favorable. Conclusions Further research is required to understand the sex and gender differences contributing to implant survival, physical function, and pain relief after TKA.Strategies need to be developed to identify any patient who is at higher risk of implant failure, suboptimal postoperative function, and incomplete pain relief.

“…Gender-specific TKA implants are a current and debated issue [8,10,11,14,20], especially after a new TKA system has been introduced that is marketed specifically to women. The rationale for that gender-specific TKA design is based on the theory that there are specific anatomic differences and that function differs between men and women when the same type of design is used in both.…”

Section: Introductionmentioning

confidence: 99%

Women Recover Faster Than Men after Standard Knee Arthroplasty

Liebs¹,

Herzberg

Roth-Kroeger

et al. 2011

Background Specific anatomic differences are believed to account for gender-specific function and health-related quality of life after TKA. However, there are conflicting data in the literature regarding these gender-specific outcomes, especially as woman appear to have surgery later in the course of the disease compared with men. Questions/purposes We asked whether (1) women had worse knee function and health-related quality of life after TKA compared with men, (2) lower improvements in scores, and (3) slower recovery after surgery. Methods Using a cohort study design, we retrospectively analyzed prospectively collected data from three multicenter randomized controlled trials evaluating rehabilitation measures after standard unisex knee arthroplasty in 494 patients (141 men and 353 women). The primary outcome was selfreported physical function as measured by the WOMAC at 3, 6, 12, and 24 months after surgery. Secondary outcomes included the pain and stiffness scales of the WOMAC and the physical and mental component summaries of the SF-36. At the time of surgery, the women were on average older (70.8 versus 67.8 years), had lower mean physical function (55 versus 47), higher mean pain scores (54 versus 48), and greater stiffness (54 versus 46) as measured by the WOMAC. Results At the 3-, 6-, 12-, and 24-month followups, men and women had similar WOMAC scores. Improvements were greater for women compared with men for WOMAC 123Clin Orthop Relat Res (2011) 469:2855-2865 DOI 10.1007/s11999-011-1921 function and pain subscale scores at the 3-month (function, 28 versus 23; pain, 32 versus 25) and 6-month followups (function, 32 versus 27; pain, 36 versus 31). At the 12-and 24-month followups we noted no differences in improvement between men and women. Conclusion Although women had greater functional limitations at the time of surgery than men, they recover faster early after standard TKA although function is similar at 12 and 24 months. Women also had greater improvement of WOMAC scores after standard TKA than men. Level of Evidence Level II, prognostic study. See the guidelines for authors for a complete description of levels of evidence.