Top

Clinical Orthopaedics and Related Research®

Published in:

01-07-2011 | Symposium: AAOS/ORS/ABJS Musculoskeletal Healthcare Disparities Research Symposium

Do We Need Gender-specific Total Joint Arthroplasty?

Authors: Aaron J. Johnson, MD, Christopher R. Costa, MD, Michael A. Mont, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 7/2011

Abstract

Background

Gender-specific differences in knee and hip anatomy have been well documented. Although it has been accepted these differences exist, there is controversy regarding if and how these differences should be addressed with gender-specific implant designs.

Questions/purposes

(1) What are the anatomic and morphologic differences, if any, in the knee and hip between men and women? (2) Do gender-specific TKA designs provide better clinical functioning, survivorship, and improved fit in women? (3) How have anatomic differences in the hip been addressed, if at all, by THA?

Methods

We conducted a systematic review of the MEDLINE database to identify all articles reviewing basic science and clinical outcomes of gender-specific total knee and total hip implants. From these, we reviewed 253 studies.

Results

The anatomic studies elucidated multiple differences in the anatomy of knees and hips between men and women. All reviewed studies report similar clinical function and satisfaction scores between men and women for gender-specific TKA and no improvement in these scores when comparing gender-specific TKA to unisex TKA. Current modularity in THA appears to accommodate any anatomic differences in the hip.

Conclusions

Based on the available literature, there is no difference in the outcome of patients with a gender-specific knee arthroplasty versus a unisex arthroplasty. It does not appear gender-specific THAs would provide any benefit over current systems.

Aglietti P, Insall JN, Cerulli G. Patellar pain and incongruence. I. Measurements of incongruence. Clin Orthop Relat Res. 1983;176:217–224.PubMed

Bachmann HS, Hanenkamp S, Kornacki B, Frey UH, Bau M, Siffert W, Wedemeyer C. Gender-dependent association of the GNAS1 T393C polymorphism with early aseptic loosening after total hip arthroplasty. J Orthop Res. 2008;26:1562–1568.PubMedCrossRef

Bellemans J, Carpentier K, Vandenneucker H, Vanlauwe J, Victor J. The John Insall Award. Both morphotype and gender influence the shape of the knee in patients undergoing TKA. Clin Orthop Relat Res. 2010;468:29–36.PubMedCrossRef

Blaha JD, Mancinelli CA, Overgaard KA. Failure of sex to predict the size and shape of the knee. J Bone Joint Surg Am. 2009;91(Suppl 6):19–22.PubMedCrossRef

Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91:128–133.PubMedCrossRef

Bozic KJ, Ong K, Lau E, Kurtz SM, Vail TP, Rubash HE, Berry DJ. Risk of complication and revision total hip arthroplasty among Medicare patients with different bearing surfaces. Clin Orthop Relat Res. 2010;468:2357–2362.PubMedCrossRef

Brinckmann P, Hoefert H, Jongen HT. Sex differences in the skeletal geometry of the human pelvis and hip joint. J Biomech. 1981;14:427–430.PubMedCrossRef

Bullens PH, van Loon CJ, de Waal Malefijt MC, Laan RF, Veth RP. Patient satisfaction after total knee arthroplasty: a comparison between subjective and objective outcome assessments. J Arthroplasty. 2001;16:740–747.PubMedCrossRef

Chang HJ, Mehta PS, Rosenberg A, Scrimshaw SC. Concerns of patients actively contemplating total knee replacement: differences by race and gender. Arthritis Rheum. 2004;51:117–123.PubMedCrossRef

10.

Clarke HD, Hentz JG. Restoration of femoral anatomy in TKA with unisex and gender-specific components. Clin Orthop Relat Res. 2008;466:2711–2716.PubMedCrossRef

11.

Csintalan RP, Schulz MM, Woo J, McMahon PJ, Lee TQ. Gender differences in patellofemoral joint biomechanics. Clin Orthop Relat Res. 2002;402:260–269.PubMedCrossRef

12.

Dargel J, Michael JW, Feiser J, Ivo R, Koebke J. Human knee joint anatomy revisited: morphometry in the light of sex-specific total knee arthroplasty. J Arthroplasty. 2010 March 3 [Epub ahead of print].

13.

Ding C, Cicuttini F, Blizzard L, Scott F, Jones G. A longitudinal study of the effect of sex and age on rate of change in knee cartilage volume in adults. Rheumatology (Oxford). 2007;46:273–279.CrossRef

14.

Ding C, Cicuttini F, Scott F, Glisson M, Jones G. Sex differences in knee cartilage volume in adults: role of body and bone size, age and physical activity. Rheumatology (Oxford). 2003;42:1317–1323.CrossRef

15.

Eckstein F, Siedek V, Glaser C, Al-Ali D, Englmeier KH, Reiser M, Graichen H. Correlation and sex differences between ankle and knee cartilage morphology determined by quantitative magnetic resonance imaging. Ann Rheum Dis. 2004;63:1490–1495.PubMedCrossRef

16.

Emerson RH Jr, Martinez J. Men versus women: does size matter in total knee arthroplasty? Clin Orthop Relat Res. 2008;466:2706–2710.PubMedCrossRef

17.

Faber SC, Eckstein F, Lukasz S, Muhlbauer R, Hohe J, Englmeier KH, Reiser M. Gender differences in knee joint cartilage thickness, volume and articular surface areas: assessment with quantitative three-dimensional MR imaging. Skeletal Radiol. 2001;30:144–150.PubMedCrossRef

18.

Fehring TK, Odum SM, Hughes J, Springer BD, Beaver WB Jr. Differences between the sexes in the anatomy of the anterior condyle of the knee. J Bone Joint Surg Am. 2009;91:2335–2341.PubMedCrossRef

19.

Grelsamer RP, Dubey A, Weinstein CH. Men and women have similar Q angles: a clinical and trigonometric evaluation. J Bone Joint Surg Br. 2005;87:1498–1501.PubMed

20.

Guerra JP, Arnold MJ, Gajdosik RL. Q angle: effects of isometric quadriceps contraction and body position. J Orthop Sports Phys Ther. 1994;19:200–204.PubMed

21.

Hanna FS, Bell RJ, Cicuttini FM, Davison SL, Wluka AE, Davis SR. The relationship between endogenous testosterone, preandrogens, and sex hormone binding globulin and knee joint structure in women at midlife. Semin Arthritis Rheum. 2007;37:56–62.PubMedCrossRef

22.

Hanna FS, Teichtahl AJ, Wluka AE, Wang Y, Urquhart DM, English DR, Giles GG, Cicuttini FM. Women have increased rates of cartilage loss and progression of cartilage defects at the knee than men: a gender study of adults without clinical knee osteoarthritis. Menopause. 2009;16:666–670.PubMedCrossRef

23.

Hernborg J, Nilsson BE. Age and sex incidence of osteophytes in the knee joint. Acta Orthop Scand. 1973;44:66–68.PubMedCrossRef

24.

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(Suppl 4):115–122.PubMed

25.

Holtzman J, Saleh K, Kane R. Gender differences in functional status and pain in a Medicare population undergoing elective total hip arthroplasty. Med Care. 2002;40:461–470.PubMedCrossRef

26.

Horton MG, Hall TL. Quadriceps femoris muscle angle: normal values and relationships with gender and selected skeletal measures. Phys Ther. 1989;69:897–901.PubMed

27.

Hsu RW, Himeno S, Coventry MB, Chao EY. Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res. 1990;255:215–227.PubMed

28.

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.PubMedCrossRef

29.

Kennedy DM, Hanna SE, Stratford PW, Wessel J, Gollish JD. Preoperative function and gender predict pattern of functional recovery after hip and knee arthroplasty. J Arthroplasty. 2006;21:559–566.PubMedCrossRef

30.

Kersnic B, Iglic A, Kralj-Iglic V, Jaklic A, Srakar F, Pernus F, Antolic V. Determination of the femoral and pelvic geometrical parameters that are important for the hip joint contact stress: differences between female and male. Pflugers Arch. 1996;431(6 Suppl 2):R207–R208.PubMedCrossRef

31.

Kim YH, Choi Y, Kim JS. Comparison of a standard and a gender-specific posterior cruciate-substituting high-flexion knee prosthesis: a prospective, randomized, short-term outcome study. J Bone Joint Surg Am. 2010;92:1911–1920.PubMedCrossRef

32.

Kim YH, Choi Y, Kim JS. Comparison of standard and gender-specific posterior-cruciate-retaining high-flexion total knee replacements: a prospective, randomised study. J Bone Joint Surg Br. 2010;92:639–645.PubMed

33.

Kostamo T, Bourne RB, Whittaker JP, McCalden RW, MacDonald SJ. No difference in gender-specific hip replacement outcomes. Clin Orthop Relat Res. 2009;467:135–140.PubMedCrossRef

34.

Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.PubMedCrossRef

35.

Kurtz SM, Ong KL, Schmier J, Zhao K, Mowat F, Lau E. Primary and revision arthroplasty surgery caseloads in the United States from 1990 to 2004. J Arthroplasty. 2009;24:195–203.PubMedCrossRef

36.

Lavernia CJ, Alcerro JC, Contreras JS, Rossi MD. Patient Perceived Outcomes After Primary Hip Arthroplasty: Does Gender Matter? Clin Orthop Relat Res. 2010 August 11 [Epub ahead of print].

37.

Mahoney OM, Kinsey T. Overhang of the femoral component in total knee arthroplasty: risk factors and clinical consequences. J Bone Joint Surg Am. 2010;92:1115–1121.PubMedCrossRef

38.

Mall G, Graw M, Gehring K, Hubig M. Determination of sex from femora. Forensic Sci Int. 2000;113:315–321.PubMedCrossRef

39.

Ong KL, Lau E, Suggs J, Kurtz SM, Manley MT. Risk of subsequent revision after primary and revision total joint arthroplasty. Clin Orthop Relat Res. 2010;468:3070–3076.PubMedCrossRef

40.

Petterson SC, Raisis L, Bodenstab A, Snyder-Mackler L. Disease-specific gender differences among total knee arthroplasty candidates. J Bone Joint Surg Am. 2007;89:2327–2333.PubMedCrossRef

41.

Poilvache PL, Insall JN, Scuderi GR, Font-Rodriguez DE. Rotational landmarks and sizing of the distal femur in total knee arthroplasty. Clin Orthop Relat Res. 1996;331:35–46.PubMedCrossRef

42.

Purkait R. Sex determination from femoral head measurements: a new approach. Leg Med (Tokyo). 2003;5(Suppl 1):S347–S350.

43.

Purkait R. Triangle identified at the proximal end of femur: a new sex determinant. Forensic Sci Int. 2005;147:135–139.PubMedCrossRef

44.

Suda AJ, Seeger JB, Bitsch RG, Krueger M, Clarius M. Are patients’ expectations of hip and knee arthroplasty fulfilled? A prospective study of 130 patients. Orthopedics. 2010;33:76–80.PubMedCrossRef

45.

Tanavalee A, Rojpornpradit T, Khumrak S, Ngarmukos S. The early results of gender-specific total knee arthroplasty in Thai patients. Knee. 2010 October 30 [Epub ahead of print].

46.

Traina F, De Clerico M, Biondi F, Pilla F, Tassinari E, Toni A. Sex differences in hip morphology: is stem modularity effective for total hip replacement? J Bone Joint Surg Am. 2009;91(Suppl 6):121–128.PubMedCrossRef

47.

van der Esch M, Steultjens MP, Lems WF, Dekker J. Gender difference in varus-valgus laxity in osteoarthritis of the knee. Scand J Rheumatol. 2007;36:157–159.PubMedCrossRef

48.

Wheatley BP. An evaluation of sex and body weight determination from the proximal femur using DXA technology and its potential for forensic anthropology. Forensic Sci Int. 2005;147:141–145.PubMedCrossRef

49.

Whittle J, Steinberg EP, Anderson GF, Herbert R, Hochberg MC. Mortality after elective total hip arthroplasty in elderly Americans: age, gender, and indication for surgery predict survival. Clin Orthop Relat Res. 1993;295:119–126.PubMed

50.

Woodland LH, Francis RS. Parameters and comparisons of the quadriceps angle of college-aged men and women in the supine and standing positions. Am J Sports Med. 1992;20:208–211.PubMedCrossRef

51.

Yates LB, Karasik D, Beck TJ, Cupples LA, Kiel DP. Hip structural geometry in old and old-old age: similarities and differences between men and women. Bone. 2007;41:722–732.PubMedCrossRef

Title: Do We Need Gender-specific Total Joint Arthroplasty?
Authors: Aaron J. Johnson, MD
Christopher R. Costa, MD
Michael A. Mont, MD
Publication date: 01-07-2011
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 7/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-011-1769-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Do We Need Gender-specific Total Joint Arthroplasty?

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2011

Breakout Session: Ethnic and Gender Differences in Diabetic Foot Management and Amputations

Mortality in Female War Veterans of Operations Enduring Freedom and Iraqi Freedom

Gender Differences in Osteoporosis and Fractures

Breakout Session: Sex/Gender and Racial/Ethnic Disparities in the Care of Osteoporosis and Fragility Fractures

Is Total Hip Arthroplasty after Hip Arthrodesis as Good as Primary Arthroplasty?

Erratum to: The Classic: Report on the Positive Results Obtained by the Modern Surgical Experiment Regarding the Suture and Replacement of Defects of Superior Tissue, as well as the Utilization of Re-absorbable and Living Tamponade in Surgery