Females and males had similar (p = 0.15) hospital length of stay (4.6 days ± 1.9 SD) (5.0 days ± 2.2 SD. There was no relationship (phi = 0.29) between type of complication and whether being male or female (Table 6).
While THA improves function with high long-term survivorship, differences in function and disability between men and women before and after arthroplasty are not well understood. Our initial goal of this study was to compare perceived measures of well-being, function, and pain between females and males before and after THA. We therefore (1) compared perceived measures of well-being, function, and pain between females and males before THA and on average 5 years; (2) compared the improvement in perceived measures of well-being, function, pain, and ROM between females and males at followup; and (3) determined the time course of perceived functional recovery in females and males by presenting the results graphically over time.
Limitations of this study include the following: First, we did not include other potential confounding factors such as race, ethnicity, socioeconomic status, or patient expectations. Such confounding factors could explain some of the differences independent of gender and we cannot ensure any differences we observed were not due to uncontrolled variables. However, we did have a fairly large number of participants and did account for age and body mass index covariates in our statistical model. Second, the differences between genders before surgery measured in our study and those previously reported could be differences in self-perception by gender. Women could perceive their pain and function as more limiting than what they really are or, alternatively, males could overestimate their pain relief and functional performance. Benyamini et al. found women’s perception of their self-assessed health ratings mostly responds to a wide range of nonhealth-related (dimensions that are not related to mortality) as well as health-related factors, whereas men’s tend to be more closely tied to their physical status when performing this assessment . Under the same premise, Kennedy et al. reported low to moderate correlations between self-report and physical performance measures in patients awaiting THA and TKA . These studies suggest objective evaluations should be included in future studies. Thus, we recommend that further investigations be completed that include both perceived and functional performance measures when evaluating differences between women and men after joint arthroplasty.
We found women reported lower preoperative scores, and despite their greater improvements in certain measures of perceived function, women continue to have lower postoperative scores when compared with men 5 years 6 months after surgery. These findings suggest perhaps women tolerate pain and disability better than males and are able to perform their activities of daily living with a higher level of pain when compared with males. This difference is relatively small and its clinical importance remains questionable.
Specific anatomic differences between men and women have been described around the hip. On the femoral side, specific differences are reported in femoral offset and femoral head height [27, 30]. However, we found no difference in ROM between men and women at the preoperative assessment. At followup women had greater mean hip abduction and internal rotation compared with men (Table 7).
Examining the time course of recovery, it appears that perceived well-being, pain, and physical function declines through 4 to 5 years after surgery in men; this decline was not observed in women.
Our data showed no difference in length of stay between females and males and a similar number and type of complications between genders. In agreement with our study, numerous reports have found no difference in complications between females and males after total joint arthroplasty [16, 24, 29].
Women do very well after primary THA in the areas of perceived clinical outcome and perceived pain relief. However, globally women presented to surgery with lower preoperative scores when compared with men. Women do have equal or better hip ROM 5 years 6 months after surgery and present with better perceived recovery than men through 7 years after THA.
We thank Mercy Hospital, the Mercy Foundation, and the Arthritis Surgery Research Foundation Inc for the financial support received to perform this investigation.
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