The John Insall Award: gender-specific total knee replacement: prospectively collected clinical outcomes.
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.


METHODS
Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
MacDonald
Steven J
SJ
Division of Orthopaedic Surgery, University of Western Ontario & London Health Sciences Centre, University Campus, London, ON, Canada. steven.macdonald@lhsc.on.ca
Charron
Kory D
KD
Bourne
Robert B
RB
Naudie
Douglas D
DD
McCalden
Richard W
RW
Rorabeck
Cecil H
CH
D017677:Age Distribution; D000368:Aged; D018771:Arthralgia / Q000453:epidemiology / Q000503:physiopathology*; D001363:Awards and Prizes; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009864:Ontario / Q000453:epidemiology; D009985:Orthopedics; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000503:physiopathology*; D011184:Postoperative Period; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D012720:Severity of Illness Index; D012737:Sex Factors; D012955:Societies, Medical; D013997:Time Factors; D016896:Treatment Outcome
J Arthroplasty. 2000 Jan;15(1):79-85
10654467
Acta Orthop Scand. 2000 Jun;71(3):262-7
10919297
J Knee Surg. 2002 Fall;15(4):213-7
12416902
J Arthroplasty. 2002 Dec;17(8):1028-32
12478514
J Bone Joint Surg Am. 2003;85-A Suppl 4:115-22
14652402
Clin Orthop Relat Res. 2004 Apr;(421):162-8
15123942
J Arthroplasty. 2004 Aug;19(5):613-9
15284983
Arthritis Rheum. 1994 May;37(5):687-94
8185695
Am J Med. 1997 Jun;102(6):524-30
9217666
Knee. 2006 Jan;13(1):12-4
16122927
BMC Musculoskelet Disord. 2006;7:38
16670005
Orthopedics. 2006 Sep;29(9 Suppl):S53-5
17002150
Orthopedics. 2006 Sep;29(9):768-9
17004583
Orthopedics. 2006 Sep;29(9):836-8
17004613
Knee. 2007 Aug;14(4):295-300
17600719
Am J Sports Med. 2007 Aug;35(8):1304-7
17379922
J Arthroplasty. 2007 Oct;22(7 Suppl 3):27-31
17919589
J Bone Joint Surg Br. 2007 Dec;89(12):1608-14
18057361
CMAJ. 2008 Mar 11;178(6):681-7
18332383