Implant survival, knee function, and pain relief after TKA: Are there differences between men and women?

Background: As efforts continue to improve the results of TKA, the potential influence of sex and gender on long-term survival of implants, knee function, pain relief, and patient satisfaction remains relevant, particularly given the increased incidence of osteoarthritis of the knee in women and reports that women derive equal benefit from TKA. Questions/purposes: This article reviews the literature pertinent to the question of whether long-term survival, knee function, pain relief, and patient satisfaction after TKA differ between men and women. Methods: Large clinical series (> 1000 patients) published in the last 10 years were identified in PubMed and reviewed. Results: Men may be at higher risk of revision surgery than women. Sex/gender has been consistently shown to impact both function and pain relief both before and after TKA. Although women achieve at least the same degree of functional improvement as men, women have worse preoperative physical function and do not reach the same final level of physical function as men. Likewise women may have similar or even greater improvement in pain after arthroplasty than men but still have final pain scores that are less favorable. Conclusions: Further research is required to understand the sex and gender differences contributing to implant survival, physical function, and pain relief after TKA. Strategies need to be developed to identify any patient who is at higher risk of implant failure, suboptimal postoperative function, and incomplete pain relief.