Effect of sex and living arrangement on the timing and outcome of joint replacement surgery

Abstract

Background: Studies have shown that women present for surgery at an older age and with greater dysfunction than do men; however, the explanation for this finding is unclear. We investigated the impact living status (alone or with another person) and sex on the timing and outcomes of hip and knee replacement surgery.

Methods: We surveyed 1722 patients undergoing primary hip or knee replacement surgery. Relevant covariates including demographic data, body mass index, sex, living status and comorbidities were recorded. We assessed joint pain and functional status before surgery and at 3 months and 1 year after surgery using the Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores for pain and function.

Results: In total, 22.9% (395) of all patients (29.3% of women and 14.1% of men) were living alone at the time of surgery. Compared with patients who lived with another person, those who lived alone were significantly older, had greater comorbidity and reported greater joint pain and dysfunction before surgery and 3 months and 1 year after surgery. Living alone and female sex independently predicted a greater preoperative WOMAC score, and living alone predicted an older age at the time of surgery and a poorer 1-year outcome.

Conclusion: Patients who live alone may delay joint replacement surgery until an older age and have greater joint pain and dysfunction than those who live with another person, leading to poorer 1-year outcomes.

Fig. 1

Total scores on the Western Ontario McMaster University Osteoarthritis Index (WOMAC) at baseline and 3 months and 1 year after surgery for patients who lived alone and those who lived with someone. The WOMAC scores were standardized to female sex, age 50 years, body mass index 30 kg/m² and Charlson Index score of 1.