Gender Role in Total Knee Arthroplasty: A Retrospective Analysis of Perioperative Outcomes in U.S. Patients

Abstract Background Women present later than men for total knee arthroplasty with more severe osteoarthritic disease, but achieve comparable functional improvement and implant survival and also lower rates of revision. Despite these findings, there is significant underutilization of the procedure for women compared to men. Methods We conducted a retrospective study to address the lack of information in the literature concerning the immediate and short-term perioperative outcomes between genders. The National Hospital Discharge Survey (NHDS) was evaluated between 2001 and 2010 for men and women undergoing primary total knee arthroplasty in the United States. Differences in gender, patient demographics, comorbidities, complications, length of stay, and discharge disposition were analyzed and identified. Results The growth in total knee arthroplasty was 145% for men and 131% for women over the ten-year period. Women presented with significantly higher rates of obesity, morbid obesity, post-operative transfusion rate and length of stay. In contrast, men showed a greater proportion of diabetes, postoperative wound infections, and increased mortality rates. Males were also more likely to be discharged to home, whereas females were more likely to be discharged to rehabilitation facilities. Conclusion Our findings provide important insight into the perioperative outcomes that may be influencing gender disparity in total knee arthroplasty.