Gender differences in functional status and pain in a Medicare population undergoing elective total hip arthroplasty.
BACKGROUND
The major indication for total hip arthroplasty (THA) is pain and disability in the hip. Evidence from state and local studies suggests that women may be more disabled than men at the time of THA. Whether worse disability at the time to THA affects outcomes is unknown.


OBJECTIVE
To examine differences in functional status and pain in men and women at the time of THA and at 1 year in a nationally representative Medicare population.


METHODS
Cohort of patients undergoing THA. Data were collected at the time of THA, 4 to 6 months after surgery, and 1 year after surgery.


METHODS
All Medicare recipients older than age 65 in 12 selected states were eligible.


METHODS
One thousand six hundred forty patients who underwent THA were identified and 1120 (432 men and 688 women) were enrolled.


METHODS
Pain and functional status.


RESULTS
At the time of THA, women were more likely than men to report severe pain with walking (67% vs. 58%; P <0.01), and needing assistance with walking (56% vs. 45%; P <0.01), housework (49% vs. 30%; P <0.01), and grocery shopping (51% vs. 31%; P <0.01). Men could also walk greater distances. These differences persisted after adjustment for comorbidities and age. One year following THA, women were more likely to report needing assistance with walking (30% vs. 21%; P <0.01), housework (29% vs. 23%; P <01), and grocery shopping (27% vs. 19%; P <0.01) and could walk shorter distances. These differences were partially accounted for by differences in comorbidities and baseline status.


CONCLUSIONS
Compared with men, women in Medicare are more disabled at the time of THA and do not do as well at 1 year. Whether this difference arises from patients' preferences or bias in the health care system is unknown.
Holtzman
Jeremy
J
Clinical Outcomes Research Center, Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis 55455, USA. holtz001@tc.umn.edu
Saleh
Khal
K
Kane
Robert
R
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000453:epidemiology*; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D015897:Comorbidity; D004185:Disability Evaluation; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D010146:Pain / Q000453:epidemiology*; D017678:Sex Distribution; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology