Sex differences in perceived expectations of the outcome of total hip and knee arthroplasties and their fulfillment: an observational cohort study

Abstract

The influence of sex on preoperative expectations and their fulfillment following total hip and knee arthroplasty (THA/TKA) remains unexplored. We investigated differences between men and women in perceived preoperative expectations on the outcome of THA/TKA and their fulfillment 1 year postoperatively. We performed a cohort study. Expectations were collected preoperatively and 1 year postoperatively using the Hospital for Special Surgery Hip/Knee Replacement Expectations Surveys (HSS-HRES/KRES; not applicable = 0, applicable: back to normal = 1, much = 2/moderate = 3/slight improvement = 4). Fulfillment of expectations was calculated by subtracting preoperative from postoperative scores (score < 0:unfulfilled; score ≥ 0:fulfilled). We included patients with “applicable” expectations. Chi-square and ordinal regression were used to compare expectations and fulfillment regarding sex. 2333 THA (62% women) and 2398 TKA (65% women) patients were included. 77% of THA and 76% of TKA patients completed the HSS-HRES/HSS-KRES both preoperatively and 1 year postoperatively. Men more often perceived items as “applicable”, with differences in 9/20 (HSS-HRES) and 9/19 (HSS-KRES) preoperative items and, respectively, 12/20 (HSS-HRES) and 10/19 (HSS-KRES) postoperative items. The largest differences (> 10%) were found in sexual activity and working ability. 16/20 (HSS-HRES) and 14/19 (HSS-KRES) items showed an increased probability of having higher preoperative expectations of ≥ 10%, in favor of men. In all items, 60% of the respondents indicated that their expectation was fulfilled. Differences were observed in 16/20 (HSS-HRES) and 6/19 (HSS-KRES) items in favor of men. Sex differences were present in expectations and fulfillment, with higher applicability of items, preoperative expectations and fulfillment in men, especially on items related to functional activities.Trial registration: Trial-ID NTR3348.

Women Are Underrepresented Among Principal Investigators of Hip and Knee Arthroplasty Clinical Trials in the United States

“…Although an emerging topic of research, the concordance of demographic characteristics between health-care providers and patients may have numerous benefits that lead to more equitable access to health care among underrepresented groups. Furthermore, unique considerations exist for female patients, including different patient expectations, complications, and surgical outcomes following total joint arthroplasty surgery 19-24 . Considering that trial findings are disseminated into clinical care guidelines and protocols, adequate sex diversity of clinical trial participants ensures that these findings apply equally to men and women.…”

“…Appropriate planning and guidance are needed to advise women before surgery regarding different expectations and a potentially unique set of complications following hip and knee arthroplasty. Research has shown that, compared with men, women have worse postoperative outcomes following hip and knee arthroplasty, such as higher rates of infection and venous thromboembolism and lower patient satisfaction 21-27 . Sex discordance between surgeons and patients can lead to worse surgical outcomes, including increased complications and even death 12 .…”

Real-world gait and turning in individuals scheduled for total knee arthroplasty

“…As walking itself may counteract functional decline (6)(7)(8)(9), low walking activity could lead to further worsening of gait capacity in individuals with knee OA. Given this apparent vicious circle between limitations in gait capacity and walking activity, mitigating walking limitations is of great importance to individuals with knee OA (10) and constitutes a reason to consider total knee arthroplasty (TKA) (11,12). Insights about the extent of walking limitation is therefore relevant for individuals with knee OA opting for TKA.…”