LAS VEGAS—While men and women have similar levels of improvement following total knee replacement (TKR) surgery, men have higher levels of function before and after TKR, according to new research presented at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).
According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed in the United States each year. In 2012, 393,345 women and 237,896 men underwent TKR, most often to alleviate the pain and immobility associated with late-stage arthritis. While research has looked at the anatomic differences between the knees of men and women, the higher levels of arthritis in women versus men, and the utilization of TKR among men and women, there has been little study on how gender influences the level of function before and after surgery.
In this study, researchers identified and studied 287 TKR patients at 7 different institutions between 2005 and 2007. All of the patients were between the ages of 21 and 80 years at the time of surgery and had a body mass index less than 40 g/m². All of the patients except 2 had a diagnosis of end-stage arthritis. The patient group included 108 men (112 knees) with a mean age of 67 years, and 170 women with a mean age of 66 years. All of the patients were evaluated preoperatively and at the following 6 points following surgery: 6 weeks, 3 months, 1 year, 2 years, 5 years, and 7 years. A Kaplan-Meier assessment gauged implant survival, and quality-of-life measurements were taken at 3 and 4 years post-surgery. During each evaluation, researchers measured knee function, range of motion, extremity activity, and overall health.
At 5 years post-surgery, implant survival was 100% for men and 99.1% for women. Range of motion also was nearly identical between genders. Functional scores were consistently higher for the men versus women: preoperatively, 57.1 versus 51; postoperatively at 6 weeks, 63.7 versus 51.5; at 3 months, 83.1 versus 74.3; at 2 years, 90 versus 81.6; at 5 years, 90.1 versus 82.9; and at 7 years, 96 versus 79.5. Men also recovered faster within the 6-week recovery time after surgery; however, both genders had almost identical improvement in mean knee score function (improvement from presurgical levels) at 5 years.
“Our data supports that while both genders benefit from TKR, men have higher levels of function and activity both prior to and after TKR compared to women,” said investigators Jeffrey J. Cherian, DO, and Michael A. Mont, MD. “These functional outcome differences are most likely due to many factors, including biologic/genetic, and highlight the need for further research related to the role of gender of both the patient and the surgeon in the decision making process of TKR, sex-based biological differences in functional recovery capacity, and whether sex/gender based pre- and postoperative rehabilitation protocols are warranted.”