Gender-specific total knee replacement design is a recent and debated topic. We determined the survivorship and clinical outcomes of a large primary total knee arthroplasty cohort, specifically assessing any differences between gender groups. A consecutive cohort of 3817 patients with 5279 primary total knee replacements (3100 female, 2179 male) with a minimum of 2 years followup were evaluated. Preoperative, latest, and change in clinical outcome scores (WOMAC, SF-12, KSCRS) were compared. While men had higher raw scores preoperatively, women had greater improvement in all WOMAC domains including pain (29.87 versus 27.3), joint stiffness (26.78 versus 24.26), function (27.21 versus 23.09), and total scores (28.35 versus 25.09). There were no gender differences in improvements of the SF-12 physical scores. Men had greater improvement in Knee Society function (22.1 versus 18.63) and total scores (70.01 versus 65.42), but not the Knee Society knee score (47.83 versus 46.64). Revision rates were 10.2% for men and 8% for women. Women demonstrated greater implant survivorship, greater improvement in WOMAC scores, equal improvements in SF-12 scores, and less improvement in only the Knee Society function and total scores. The data refute the hypothesis of inferior clinical outcome for women following total knee arthroplasty when using standard components.
Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Borkhoff CM, Hawker GA, Kreder HJ, Glazier RH, Mahomed NN, Wright JG. The effect of patients’ sex on physicians’ recommendations for total knee arthroplasty. CMAJ. 2008;178:681–687.PubMedGoogle Scholar
Chin KR, Dalury DF, Zurakowski D, Scott RD. Intraoperative measurements of male and female distal femurs during primary total knee arthroplasty. J Knee Surg. 2002;15:213–217.PubMedGoogle Scholar
Harrysson OLA, Robertsson O, Nayfeh JF. Higher cumulative revision rate of knee arthroplasties in younger patients with osteoarthritis. Clin Orthop Relat Res. 2004;421:162–168.PubMedCrossRefGoogle Scholar
Hitt K, Shurman JR 2nd, Greene K, McCarthy J, Moskal J, Hoeman T, Mont MA. Anthropometric measurements of the human knee: correlation to the sizing of current knee arthroplasty systems. J Bone Joint Surg Am. 2003;85:115–122.PubMedCrossRefGoogle Scholar
Ho WP, Cheng CK, Liau JJ. Morphometrical measurements of resected surface of femurs in Chinese knees: Correlation to the sizing of current femoral implants. Knee. 2006;13:12–14.PubMedCrossRefGoogle Scholar
Karlson EW, Daltroy LH, Liang MH, Eaton HE, Katz JN. Gender differences in patient preferences may underlie differential utilization of elective surgery. Am J Med. 1997;102:524–530.PubMedCrossRefGoogle Scholar
Katz JN, Wright EA, Guadagnoli E, Liang MH, Karlson EW, Cleary PD. Differences between men and women undergoing major orthopedic surgery for degenerative arthritis. Arthritis Rheum. 1994;37:687–694.PubMedCrossRefGoogle Scholar
Kwak DS, Surendran S, Pengatteeri YH, Park SE, Choi KN, Gopinathan P, Han SH, Han CW. Morphometry of the proximal tibia to design the tibial component of total knee arthroplasty for the Korean population. Knee. 2007;14:295–300.PubMedCrossRefGoogle Scholar
Paradowski PT, Bergman S, Sunden-Lundius A, Lohmander LS, Roos EM. Knee complaints vary with age and gender in the adult population. Population-based reference data for the Knee injury and Osteoarthritis Outcome Score (KOOS). BMC Musculoskelet Disord. 2006;7:38.PubMedCrossRefGoogle Scholar
Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand. 2000;71:262–267.PubMedCrossRefGoogle Scholar
Shelbourne KD, Gray T, Benner RW. Intercondylar notch width measurement differences between African American and white men and women with intact anterior cruciate ligament knees. Am J Sports Med. 2007;35:1304–1307.PubMedCrossRefGoogle Scholar
Uehara K, Kadoya Y, Kobayashi A, Ohashi H, Yamano Y. Anthropometry of the proximal tibia to design a total knee prosthesis for the Japanese population. J Arthroplasty. 2002;17:1028–1032.PubMedCrossRefGoogle Scholar
Vaidya SV, Ranawat CS, Aroojis A, Laud NS. Anthropometric measurements to design total knee prostheses for the Indian population. J Arthroplasty. 2000;15:79–85.PubMedCrossRefGoogle Scholar
Yip DK, Zhu YH, Chiu KY, Ng TP. Distal rotational alignment of the Chinese femur and its relevance in total knee arthroplasty. J Arthroplasty. 2004;19:613–619.PubMedCrossRefGoogle Scholar