Dr. Singh has received consultancy fees, speaking fees, and/or honoraria (less than $10,000 each) from Allergan, Novartis, Regeneron, Saviant, and URL, and (more than $10,000 each) from Areda and Takeda.
Sex and Surgical Outcomes and Mortality After Primary Total Knee Arthroplasty: A Risk-Adjusted Analysis†
Article first published online: 1 JUL 2013
Copyright © 2013 by the American College of Rheumatology
Arthritis Care & Research
Volume 65, Issue 7, pages 1095–1102, July 2013
How to Cite
Singh, J. A., Kwoh, C. K., Richardson, D., Chen, W. and Ibrahim, S. A. (2013), Sex and Surgical Outcomes and Mortality After Primary Total Knee Arthroplasty: A Risk-Adjusted Analysis. Arthritis Care Res, 65: 1095–1102. doi: 10.1002/acr.21953
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.
- Issue published online: 1 JUL 2013
- Article first published online: 1 JUL 2013
- Accepted manuscript online: 17 JAN 2013 10:54AM EST
- Manuscript Accepted: 21 DEC 2012
- Manuscript Received: 23 AUG 2012
- Arthritis Foundation, Western Pennsylvania Chapter
- National Institute on Aging
- National Cancer Institute
- Agency for Healthcare Research and Quality Centers for Education & Research on Therapeutics
- Birmingham VA Medical Center, Alabama
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Grant Number: K24-AR-055259
Total knee arthroplasty (TKA) is a widely utilized and effective treatment option for end-stage knee osteoarthritis (OA). Knee OA is more prevalent among women compared to men, but there are limited data on the sex differences in surgical outcomes after primary TKA.
Our sample consisted of all primary TKAs performed in Pennsylvania during the fiscal year 2002. We used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify major complications and surgical revision. We used mixed-effects logistic regression models to examine the associations between sex and all-cause mortality, readmissions, and major surgical complications. We used proportional hazards models to assess the risk of surgical revision after index arthroplasty. We adjusted for race, age, hospital teaching status, hospital procedure volume, insurance status, and risk of mortality.
In 17,994 primary TKAs, there were 46 and 220 deaths at 30 days and 1 year, respectively. Compared to women, men had higher adjusted odds of 1-year mortality (odds ratio [OR] 1.48 [95% confidence interval (95% CI) 1.13–1.94]) after primary TKA. The overall odds of most major 30-day complications did not differ by sex except for surgical wound infections, which were higher in men compared to women (OR 1.31 [95% CI 1.08–1.60]); 30-day readmission was higher in men (OR 1.25 [95% CI 1.10–1.43]). Men had significantly higher rates of revision of index knee arthroplasty at 5 years (hazard ratio 1.20 [95% CI 1.05–1.36]) compared to women.
The higher rates of mortality, hospital readmissions, revision surgery, and wound infections in men undergoing elective primary TKA compared to women indicate there is a sex disparity in these outcomes.