Gender bias detected for hip arthroplasty failure

Feb 25 2013

By Lynda Williams, Senior medwireNews Reporter

Women are significantly more likely than men to experience implant failure after primary total hip arthroplasty (THA), suggests research published in JAMA Internal Medicine.

The study of 35,140 THAs showed that 97.4% of implants survived for at least 5 years but that this significantly differed between women and men, at 97.1% versus 97.7%.

Female patients were 1.29 times more likely to require all-cause revision than men and 1.32 times more likely to need aseptic revision over a median of 3 years of follow up, adjusting for age, body mass index, diabetes, American Society of Anesthesiologists score, implant fixation type, femoral head size, and bearing surface.

Similar risks were found when taking into consideration hospital volume, and surgeon training and procedure volume, report Maria Inacio (Southern California Permanente Medical Group, San Diego, USA) and co-authors.

However, women and men did not differ significantly with regard to risk for septic revision, suggesting the increased risk for all-cause revision is not related to infection, the researchers say.

"The differences in prosthesis choices in men and women, as well as the follow-up of the presented study and nonmeasured possible confounders, are important considerations when interpreting these results," they comment.

The cohort underwent surgery between 2001 and 2010, most commonly for osteoarthritis (91.4%). Women made up 57.5% of the patients and on average were significantly older than male patients (67.1 vs 63.8 years).

Women were more likely than men to receive a 28 mm femoral head (28.2 vs 13.1%) and a metal-on-highly cross-linked polyethylene-bearing surfaces implant (60.6 vs 53.7%), whereas men were more likely to receive a 36 mm or larger head (55.4 vs 32.8%) and metal-on-metal implants (19.4 vs 9.6%).

Writing in an accompanying commentary, Diana Zuckerman (National Research Center for Women and Families, Washington DC, USA) highlights the lack of long-term comparative published research on the risks and benefits of different THA devices in men and women.

She explains these data are necessary to help patients make better informed choices on their procedure and implant, and reduce the risk for revision surgery.

"Premarket clinical trial data would be especially likely to save lives, improve the quality of lives, and save billions of health care dollars, given the enormous number of operations and costs associated with each procedure," she emphasizes.

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