Department of Population Health Sciences, Weill Cornell College of Medicine, New York, New York.
Kaiser Permanente, San Diego, California.
JAMA Netw Open. 2021 Jun 1;4(6):e2110687. doi: 10.1001/jamanetworkopen.2021.10687.
The worldwide population is aging and includes more female individuals than male individuals, with higher rates of total hip arthroplasty (THA) among female individuals. Although research on this topic has been limited to date, several studies are currently under way.
To evaluate the association between sex and 2-year revision after THA.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from statewide databases in New York and California between October 1, 2015, and December 31, 2018. Patients 18 years or older with osteoarthritis who underwent THA and had sex recorded in the database were included in the analysis.
Total hip arthroplasty.
The outcome of interest was the difference in early, all-cause revision surgery rates after primary THA between women and men. The association of sex with the revision rate was examined using Cox proportional hazards regression analysis.
Of 132 826 patients included in the study, 74 002 (55.7%) were women; the mean (SD) age was 65.9 (11.0) years, and the median follow-up time was 1.3 years (range, 0.0-3.0 years). The 2-year revision rate was 2.5% (95% CI, 2.4%-2.6%) among women and 2.1% (95% CI, 2.0%-2.2%) among men. After adjusting for demographic characteristics, comorbidities, and facility volume, a minimal clinically meaningful difference was observed in revision rates despite women having a higher risk of all-cause revision compared with men (hazard ratio, 1.16; 95% CI, 1.07-1.26; P < .001). The risk of revision was increased among women compared with men in the subgroup of patients who were younger than 55 years (hazard ratio, 1.47; 95% CI, 1.20-1.81; P < .001).
In this cohort study, no clinically meaningful difference in all-cause revision rates after primary THA was found between men and women at 2-year follow-up. The modest difference in the risk of revision between men and women in a small subgroup of patients younger than 55 years suggests that the risk of revision in this population should be studied further.
全球人口正在老龄化，女性人口多于男性，女性全髋关节置换术 (THA) 的比例更高。尽管迄今为止，针对这一主题的研究有限，但目前正在进行几项研究。
评估 THA 后 2 年翻修与性别的关联。
设计、地点和参与者：本队列研究使用了 2015 年 10 月 1 日至 2018 年 12 月 31 日期间纽约州和加利福尼亚州全州数据库中的数据。分析纳入数据库中记录有性别的 18 岁或以上患有骨关节炎并接受 THA 的患者。
全髋关节置换术。
主要结局是女性和男性初次 THA 后早期、全因翻修手术率的差异。使用 Cox 比例风险回归分析检查性别与翻修率的关联。
在纳入研究的 132826 例患者中，74002 例（55.7%）为女性；平均（SD）年龄为 65.9（11.0）岁，中位随访时间为 1.3 年（范围，0.0-3.0 年）。女性 2 年翻修率为 2.5%（95%CI，2.4%-2.6%），男性为 2.1%（95%CI，2.0%-2.2%）。在调整了人口统计学特征、合并症和机构容量后，尽管女性全因翻修的风险高于男性，但仍观察到翻修率有微小的临床意义差异（风险比，1.16；95%CI，1.07-1.26；P<.001）。与男性相比，55 岁以下的女性患者亚组的翻修风险更高（风险比，1.47；95%CI，1.20-1.81；P<.001）。
在这项队列研究中，在 2 年随访时，男性和女性初次 THA 后的全因翻修率没有明显的临床差异。在年龄小于 55 岁的小亚组患者中，男性和女性翻修风险的差异较小，表明这一人群的翻修风险需要进一步研究。
