Document Detail

Sex and risk of hip implant failure: assessing total hip arthroplasty outcomes in the United States.
MedLine Citation:
PMID:  23420484     Owner:  NLM     Status:  MEDLINE    
IMPORTANCE: The role of sex in relationship to implant failure after total hip arthroplasty (THA) is important for patient management and device innovation.
OBJECTIVE: To evaluate the association of sex with short-term risk of THA revision after adjusting for patient, implant, surgery, surgeon, and hospital confounders.
DESIGN AND SETTING: A prospective cohort of patients enrolled in a total joint replacement registry from April 1, 2001, through December 31, 2010.
PARTICIPANTS: Patients undergoing primary, elective, unilateral THA.
MAIN OUTCOME MEASURES: Failure of THA, defined as revision procedure for (1) any reason, (2) septic reason, or (3) aseptic reason after the index procedure.
RESULTS: A total of 35,140 THAs with 3.0 years of median follow-up were identified. Women constituted 57.5% of the study sample, and the mean (SD) patient age was 65.7 (11.6) years. A higher proportion of women received 28-mm femoral heads (28.2% vs 13.1%) and had metal on highly cross-linked polyethylene-bearing surfaces (60.6% vs 53.7%) than men. Men had a higher proportion of 36-mm or larger heads (55.4% vs 32.8%) and metal on metal-bearing surfaces (19.4% vs 9.6%). At 5-year follow-up, implant survival was 97.4% (95% CI, 97.2%-97.6%). Device survival for men (97.7%; 95% CI, 97.4%-98.0%) vs women (97.1%; 95% CI, 96.8%-97.4%) was significantly different (P = .01). After adjustments, the hazards ratios for women were 1.29 (95% CI, 1.11-1.51) for all-cause revision, 1.32 (95% CI, 1.10-1.58) for aseptic revision, and 1.17 (95% CI, 0.81-1.68) for septic revision.
CONCLUSIONS: After considering patient-, surgery-, surgeon-, volume-, and implant-specific risk factors, women had a 29% higher risk of implant failure than men after THA in this community-based sample.
Maria C S Inacio; Christopher F Ake; Elizabeth W Paxton; Monti Khatod; Cunlin Wang; Thomas P Gross; Ronald G Kaczmarek; Danica Marinac-Dabic; Art Sedrakyan
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  JAMA internal medicine     Volume:  173     ISSN:  2168-6114     ISO Abbreviation:  JAMA Intern Med     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-26     Completed Date:  2013-05-24     Revised Date:  2013-10-25    
Medline Journal Info:
Nlm Unique ID:  101589534     Medline TA:  JAMA Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  435-41     Citation Subset:  AIM; IM    
Surgical Outcomes and Analysis Department, Southern California Permanente Medical Group, 8954 Rio San Diego Dr, Ste 406, San Diego, CA 92108, USA.
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MeSH Terms
Arthroplasty, Replacement, Hip* / adverse effects,  instrumentation
Cohort Studies
Equipment Failure Analysis
Middle Aged
Prosthesis Design* / methods,  statistics & numerical data
Prosthesis Failure / etiology*
Reoperation / statistics & numerical data*
Risk Assessment
Risk Factors
Sex Distribution
Sex Factors
Surgical Procedures, Elective / adverse effects,  methods,  statistics & numerical data
Treatment Outcome
United States
Grant Support
HHSF22200860493P//PHS HHS
Comment In:
JAMA Intern Med. 2013 Mar 25;173(6):442-3   [PMID:  23420302 ]
JAMA Intern Med. 2013 Sep 9;173(16):1557-8   [PMID:  24030763 ]
JAMA Intern Med. 2013 Sep 9;173(16):1558-9   [PMID:  24030765 ]
JAMA Intern Med. 2013 Sep 9;173(16):1558   [PMID:  24030764 ]

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