Do we need gender-specific total joint arthroplasty?

Abstract

Background: Gender-specific differences in knee and hip anatomy have been well documented. Although it has been accepted these differences exist, there is controversy regarding if and how these differences should be addressed with gender-specific implant designs.

Questions/purposes: (1) What are the anatomic and morphologic differences, if any, in the knee and hip between men and women? (2) Do gender-specific TKA designs provide better clinical functioning, survivorship, and improved fit in women? (3) How have anatomic differences in the hip been addressed, if at all, by THA?

Methods: We conducted a systematic review of the MEDLINE database to identify all articles reviewing basic science and clinical outcomes of gender-specific total knee and total hip implants. From these, we reviewed 253 studies.

Results: The anatomic studies elucidated multiple differences in the anatomy of knees and hips between men and women. All reviewed studies report similar clinical function and satisfaction scores between men and women for gender-specific TKA and no improvement in these scores when comparing gender-specific TKA to unisex TKA. Current modularity in THA appears to accommodate any anatomic differences in the hip.

Conclusions: Based on the available literature, there is no difference in the outcome of patients with a gender-specific knee arthroplasty versus a unisex arthroplasty. It does not appear gender-specific THAs would provide any benefit over current systems.

Fig. 1

A flowchart illustrates the results of our search strategy using our inclusion and exclusion criteria.