Outcomes/Effectiveness Research

Degree of disability at surgery may explain differences between men and women in outcomes of hip replacement surgery

Elderly women suffer longer than men from the pain and disability of arthritis of the hip before they opt for surgery. They are in worse shape than men by the time they have total hip arthroplasty (THA, surgical reconstruction or replacement of the degenerated joint), and their delay in undergoing surgery may explain why they are not doing as well as men 1 year after the procedure, according to a study supported by the Agency for Healthcare Research and Quality (HS09735).

University of Minnesota researchers led by Jeremy Holtzman, M.D., M.S., examined differences in functional status and pain at the time of THA and 1 year later in 1,120 elderly Medicare HMO beneficiaries (432 men and 688 women) in 12 States. At the time of THA, women were more likely than men to report severe pain with walking (67 vs. 58 percent) and need for assistance with walking (56 vs. 45 percent), housework (49 vs. 30 percent), and grocery shopping (51 vs. 31 percent). Men could also walk greater distances than women prior to THA. These differences between men and women persisted, even after adjustments were made for ages and coexisting medical problems. One year following THA, women were more likely than men to report needing help with walking (30 vs. 21 percent), housework (29 vs. 23 percent), and grocery shopping (27 vs. 19 percent), and they were able to walk shorter distances than men.

Operating on women with less disability should improve their outcomes, suggest the researchers. They point out, however, that women's worse outcomes may have been due to unmeasured coexisting conditions among women, their more sedentary lifestyle, or true inferiority of outcomes (perhaps poorer rehabilitation of women following surgery). On the other hand, women may not be referred to orthopedic surgeons until they have a greater degree of disability, or they may have different desires than men regarding referral and surgery.

See "Gender differences in functional status and pain in a Medicare population undergoing elective total hip arthroplasty," by Dr. Holtzman, Khal Saleh, M.D., and Robert Kane, M.D., in Medical Care 40(6), pp. 461-470.

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