title: Effect of sex and living arrangement on the timing and outcome of joint replacement surgery.
abstract: BACKGROUND
  Studies have shown that women present for surgery at an older age and with greater dysfunction than do men; however, the explanation for this finding is unclear. We investigated the impact living status (alone or with another person) and sex on the timing and outcomes of hip and knee replacement surgery.
  
  
  METHODS
  We surveyed 1722 patients undergoing primary hip or knee replacement surgery. Relevant covariates including demographic data, body mass index, sex, living status and comorbidities were recorded. We assessed joint pain and functional status before surgery and at 3 months and 1 year after surgery using the Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores for pain and function.
  
  
  RESULTS
  In total, 22.9% (395) of all patients (29.3% of women and 14.1% of men) were living alone at the time of surgery. Compared with patients who lived with another person, those who lived alone were significantly older, had greater comorbidity and reported greater joint pain and dysfunction before surgery and 3 months and 1 year after surgery. Living alone and female sex independently predicted a greater preoperative WOMAC score, and living alone predicted an older age at the time of surgery and a poorer 1-year outcome.
  
  
  CONCLUSIONS
  Patients who live alone may delay joint replacement surgery until an older age and have greater joint pain and dysfunction than those who live with another person, leading to poorer 1-year outcomes.
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ont. rajiv.gandhi@uhn.on.ca
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gandhi
authors.forename: Fahad
authors.initials: F
authors.lastname: Razak
authors.forename: J Rod
authors.initials: JR
authors.lastname: Davey
authors.forename: Yoga R
authors.initials: YR
authors.lastname: Rampersaud
authors.forename: Nizar N
authors.initials: NN
authors.lastname: Mahomed
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000601:surgery; D020127:Recovery of Function; D012111:Residence Characteristics; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome