Abstract
The worldwide population is aging and includes more female individuals than male individuals, with higher rates of total hip arthroplasty (THA) among female individuals. Although research on this topic has been limited to date, several studies are currently under way. To evaluate the association between sex and 2-year revision after THA. This cohort study used data from statewide databases in New York and California between October 1, 2015, and December 31, 2018. Patients 18 years or older with osteoarthritis who underwent THA and had sex recorded in the database were included in the analysis. Total hip arthroplasty. The outcome of interest was the difference in early, all-cause revision surgery rates after primary THA between women and men. The association of sex with the revision rate was examined using Cox proportional hazards regression analysis. Of 132 826 patients included in the study, 74 002 (55.7%) were women; the mean (SD) age was 65.9 (11.0) years, and the median follow-up time was 1.3 years (range, 0.0-3.0 years). The 2-year revision rate was 2.5% (95% CI, 2.4%-2.6%) among women and 2.1% (95% CI, 2.0%-2.2%) among men. After adjusting for demographic characteristics, comorbidities, and facility volume, a minimal clinically meaningful difference was observed in revision rates despite women having a higher risk of all-cause revision compared with men (hazard ratio, 1.16; 95% CI, 1.07-1.26; P < .001). The risk of revision was increased among women compared with men in the subgroup of patients who were younger than 55 years (hazard ratio, 1.47; 95% CI, 1.20-1.81; P < .001). In this cohort study, no clinically meaningful difference in all-cause revision rates after primary THA was found between men and women at 2-year follow-up. The modest difference in the risk of revision between men and women in a small subgroup of patients younger than 55 years suggests that the risk of revision in this population should be studied further.
Highlights
Total hip arthroplasty (THA) is a common and effective elective procedure for the treatment of end-stage osteoarthritis, a leading cause of disability.[1]
After adjusting for demographic characteristics, comorbidities, and facility volume, a minimal clinically meaningful difference was observed in revision rates despite women having a higher risk of all-cause revision compared with men
In this cohort study, no clinically meaningful difference in all-cause revision rates after primary THA was found between men and women at 2-year follow-up
Summary
Total hip arthroplasty (THA) is a common and effective elective procedure for the treatment of end-stage osteoarthritis, a leading cause of disability.[1] More than 2.5 million people in the US have received a total hip replacement,[2] and the number of primary THA procedures conducted annually is projected to increase by 71% over the 10 years.[3] THA is associated with improved patient health-related quality of life,[4,5] some implants may fail, leading to the need for higher-risk revision procedures These procedures are associated with increased risk of complications or mortality.[6] Each year, more than 3% of all arthroplasties performed are hip revision procedures,[7] with the mean cost of these procedures exceeding $77 000.3. Some studies suggest an increased risk of revision associated with the male sex,[15,16,17] whereas others suggest an increased risk associated with the female sex[18,19,20,21] or no difference in risk between male and female patients.[22,23] These differences among studies may be attributed to numerous factors, such as differences in the size or demographic characteristics of the cohort, implant characteristics, the length of follow-up, and the definition of revision surgery
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