title: Gender Role in Total Knee Arthroplasty: A Retrospective Analysis of Perioperative Outcomes in US Patients.
abstract: Women present later than men for total knee arthroplasty (TKA) 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.
  
  
  
  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 was evaluated between 2001 and 2010 for men and women undergoing primary TKA in the United States. Differences in gender, patient demographics, comorbidities, complications, length of stay, and discharge disposition were analyzed and identified.
  
  
  
  The growth in TKA was 145% for men and 131% for women over the 10-year period. Women presented with significantly higher rates of obesity, morbid obesity, postoperative 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.
  
  
  
  Our findings provide important insight into the perioperative outcomes that may be influencing gender disparity in TKA.
authors.affiliation: Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Keith G
authors.initials: KG
authors.lastname: Whitlock
authors.affiliation: Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Hristo I
authors.initials: HI
authors.lastname: Piponov
authors.affiliation: Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Sapan H
authors.initials: SH
authors.lastname: Shah
authors.affiliation: Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Olivia J
authors.initials: OJ
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Gonzalez
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D005783:Gender Identity; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: TKA; comorbidities; gender; outcomes; perioperative; total knee arthroplasty