Holtzman Jeremy, Saleh Khal, Kane Robert
Clinical Outcomes Research Center, Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis 55455, USA.
Med Care. 2002 Jun;40(6):461-70. doi: 10.1097/00005650-200206000-00003.
The major indication for total hip arthroplasty (THA) is pain and disability in the hip. Evidence from state and local studies suggests that women may be more disabled than men at the time of THA. Whether worse disability at the time to THA affects outcomes is unknown.
To examine differences in functional status and pain in men and women at the time of THA and at 1 year in a nationally representative Medicare population.
Cohort of patients undergoing THA. Data were collected at the time of THA, 4 to 6 months after surgery, and 1 year after surgery.
All Medicare recipients older than age 65 in 12 selected states were eligible.
One thousand six hundred forty patients who underwent THA were identified and 1120 (432 men and 688 women) were enrolled.
Pain and functional status.
At the time of THA, women were more likely than men to report severe pain with walking (67% vs. 58%; P <0.01), and needing assistance with walking (56% vs. 45%; P <0.01), housework (49% vs. 30%; P <0.01), and grocery shopping (51% vs. 31%; P <0.01). Men could also walk greater distances. These differences persisted after adjustment for comorbidities and age. One year following THA, women were more likely to report needing assistance with walking (30% vs. 21%; P <0.01), housework (29% vs. 23%; P <01), and grocery shopping (27% vs. 19%; P <0.01) and could walk shorter distances. These differences were partially accounted for by differences in comorbidities and baseline status.
Compared with men, women in Medicare are more disabled at the time of THA and do not do as well at 1 year. Whether this difference arises from patients' preferences or bias in the health care system is unknown.
全髋关节置换术（THA）的主要指征是髋关节疼痛和功能障碍。来自州和地方研究的证据表明，在进行全髋关节置换术时，女性可能比男性功能障碍更严重。全髋关节置换术时更严重的功能障碍是否会影响治疗结果尚不清楚。
在全国具有代表性的医疗保险人群中，研究全髋关节置换术时及术后1年男性和女性在功能状态和疼痛方面的差异。
对接受全髋关节置换术的患者进行队列研究。在全髋关节置换术时、术后4至6个月以及术后1年收集数据。
12个选定州中所有年龄超过65岁的医疗保险受益人均符合条件。
确定了1640例行全髋关节置换术的患者，其中1120例（432例男性和688例女性）被纳入研究。
疼痛和功能状态。
在全髋关节置换术时，女性比男性更有可能报告行走时严重疼痛（67%对58%；P<0.01），以及行走（56%对45%；P<0.01）、家务（49%对30%；P<0.01）和购物（51%对31%；P<0.01）需要帮助。男性行走距离也更远。在对合并症和年龄进行调整后，这些差异仍然存在。全髋关节置换术后1年，女性更有可能报告行走（30%对21%；P<0.01）、家务（29%对23%；P<0.01）和购物（27%对19%；P<0.01）需要帮助，且行走距离更短。这些差异部分可由合并症和基线状态的差异来解释。
与男性相比，医疗保险中的女性在全髋关节置换术时功能障碍更严重，术后1年恢复情况也较差。这种差异是源于患者的偏好还是医疗保健系统中的偏见尚不清楚。
