The impact of gender on primary total knee replacement in Dohuk city
DOI:
https://doi.org/10.56056/Keywords:
Knee osteoarthritis, Outcome, Total Knee ArthroplastyAbstract
Background and Objectives: Osteoarthritis is the leading cause of disability and reduced quality of life among elderly patients, after a trial of conservative treatment, total joint arthroplasty is the gold standard treatment for symptomatic end-stage osteoarthritis. The aim is to assess the range of knee flexion, Oxford knee score, Knee Society Function and Knee Society Score after total knee replacement in both genders and find the differences.
Methods: This cross-sectional study was conducted in Duhok Emergency Teaching Hospital from October/2022 to October/2024. A total of 60 patients who underwent primary total knee replacement for end-stage knee osteoarthritis were involved in the study. We used non-probability (nonrandom) convenience sampling. Patients in both groups were evaluated preoperatively, as well as at 6, 12, and 24 months postoperatively. Knee flexion, oxford knee score, knee society score, and knee society function score were recorded preoperatively and postoperatively.
Results: The outcomes of primary total knee replacement showed significant differences between males and females at 6, 12, and 24 months postoperatively. Significant differences were observed in Knee Function and Knee Society Score, with p-values of 0.0012 and <0.0001, respectively, favoring females. However, no significant differences were found in Knee Flexion and Oxford Knee Score, with p-values of 0.2772 and 0.3340, respectively.
Conclusion: Compared to the male group, females showed better outcomes in Knee Society Score and Knee Society Function Score. However, no significant differences were observed in Knee Flexion and Oxford Knee Score. Age and BMI had minimal impact on postoperative outcomes following total knee replacement.
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1. Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick SG, Jordan JM et al. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med. 2000 Oct 17;133(8):635-46. doi: 10.7326/0003-4819-133-8-200010170-00016/
2. Fitzgerald GK, Piva SR, Irrgang JJ, Bouzubar F, Starz TW. Quadriceps activation failure as a moderator of the relationship between quadriceps strength and physical function in individuals with knee osteoarthritis. Arthritis Rheum. 2004 Feb 15;51(1):40-8. doi: 10.1002/art.20084. 2004; 51(1), 40–48. https://doi.org/10.1002/art.20084/
3. Messier SP, Loeser RF, Hoover JL, Semble EL, Wise CM. Osteoarthritis of the knee: effects on gait, strength, and flexibility [published correction appears in Arch Phys Med Rehabil 1992 Mar;73(3):252. Arch Phys Med Rehabil. 1992;73(1):29-36.
4. Logerstedt DS, Zeni J Jr, Snyder-Mackler L. Sex differences in patients with different stages of knee osteoarthritis. Arch Phys Med Rehabil. 2014;95(12):2376-2381. doi: 10.1016/j.apmr.2014.07.414/
5. Weinstein AM, Rome BN, Reichmann WM, Collins JE, Burbine SA, Thornhill TS, et al. Estimating the burden of total knee replacement in the United States. J Bone Joint Surg Am. 2013 Mar 6;95(5):385-92. doi: 10.2106/JBJS.L.00206. PMID: 23344005; PMCID: PMC3748969.
6. Srikanth VK, Fryer JL, Zhai G, Winzenberg TM, Hosmer D, Jones G. A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis. Osteoarthritis Cartilage. 2005;13(9):769-781. doi: 10.1016/j.joca.2005.04.014/
7. Stevens-Lapsley JE, Kohrt WM. Osteoarthritis in women: effects of estrogen, obesity and physical activity. Womens Health (Lond). 2010;6(4):601-615. doi:10.2217/whe.10.38/
8. Tonelli SM, Rakel BA, Cooper NA, Angstom WL, Sluka KA. Women with knee osteoarthritis have more pain and poorer function than men, but similar physical activity prior to total knee replacement. Biol Sex Differ. 2011; 2:12. doi:10.1186/2042-6410-2-12/
9. Borkhoff CM, Hawker GA, Kreder HJ, Glazier RH, Mahomed NN, Wright JG. The effect of patients' sex on physicians' recommendations for total knee arthroplasty. CMAJ. 2008;178(6):681-687. doi:10.1503/cmaj.071168/
10. Matsuda S, Kawahara S, Okazaki K, Tashiro Y, Iwamoto Y. Postoperative alignment and ROM affect patient satisfaction after TKA. Clin Orthop Relat Res. 2013;471(1):127-133. doi:10.1007/s11999-012-2533-y/
11. Huang Y, Lee M, Chong HC, Ning Y, Lo NN, Yeo SJ. Reasons and Factors Behind Post-Total Knee Arthroplasty Dissatisfaction in an Asian Population. Ann Acad Med Singap. 2017;46(8):303-309.
12. Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW. Patient Dissatisfaction Following Total Knee Arthroplasty: A Systematic Review of the Literature. J Arthroplasty. 2017;32(12):3854-3860. doi: 10.1016/j.arth.2017.07.021/
13. Nandi M, Schreiber KL, Martel MO, Cornelius M, Campbell CM, Haythornthwaite JA, et al. Sex differences in negative affect and postoperative pain in patients undergoing total knee arthroplasty. Biol Sex Differ. 2019 May 6;10(1):23. doi: 10.1186/s13293-019-0237-7. PMID: 31060622; PMCID: PMC6501305.
14. Cottino U, Rosso F, Pastrone A, Dettoni F, Rossi R, Bruzzone M. Painful knee arthroplasty: current practice. Curr Rev Musculoskelet Med. 2015;8(4):398-406. doi:10.1007/s12178-015-9296-5/
15. Thomas P, Summer B, Thyssen JP. Hypersensitivity Reactions to Orthopedic Implants. In: Johansen, J., Mahler, V., Lepoittevin, JP., Frosch, P. (eds) Contact Dermatitis. Springer, Cham. 2020. https://doi.org/10.1007/978-3-319-72451-5_80-2/
16. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not. Clin Orthop Relat Res. 2010;468(1):57-63. doi:10.1007/s11999-009-1119-9/
17. Dahm DL, Barnes SA, Harrington JR, Sayeed SA, Berry DJ. Patient-reported activity level after total knee arthroplasty. J Arthroplasty. 2008;23(3):401-407. doi: 10.1016/j.arth.2007.05.051/
18. Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award: Patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res. 2006; 452:35-43. doi: 10.1097/01.blo.0000238825.63648.1e/
19. Padua R, Ceccarelli E, Bondì R, Campi A, Padua L. Range of motion correlates with patient perception of TKA outcome. Clin Orthop Relat Res. 2007; 460:174-177. doi: 10.1097/BLO.0b013e318046ccb7/
20. Mont MA, Sayeed SA, Osuji O, Johnson AJ, Naziri Q, Delanois RE et al. Total knee arthroplasty in patients 40 years and younger. J Knee Surg. 2012 Mar;25(1):65-9. doi: 10.1055/s-0031-1299667. PMID: 22624250.
21. Karas V, Calkins TE, Bryan AJ, Culvern C, Nam D, Berger RA, et al. Total Knee Arthroplasty in Patients Less Than 50 Years of Age: Results at a Mean of 13 Years. J Arthroplasty. 2019 Oct;34(10):2392-2397. doi: 10.1016/j.arth.2019.05.018. Epub 2019 May 15. PMID: 31178387.
22. Fang M, Noiseux N, Linson E, Cram P. The Effect of Advancing Age on Total Joint Replacement Outcomes. Geriatr Orthop Surg Rehabil. 2015;6(3):173-179. doi:10.1177/2151458515583515/
23. Lim JB, Chi CH, Lo LE, Lo WT, Chia SL, Yeo SJ, et al. Gender difference in outcome after total knee replacement. J Orthop Surg (Hong Kong). 2015 Aug;23(2):194-7. doi: 10.1177/230949901502300216. PMID: 26321549.
24. Ritter MA, Wing JT, Berend ME, Davis KE, Meding JB. The clinical effect of gender on outcome of total knee arthroplasty. J Arthroplasty. 2008;23(3):331-336. doi: 10.1016/j.arth.2007.10.031/
25. Clement ND, Weir D, Holland J, Deehan DJ. Sex does not clinically influence the functional outcome of total knee arthroplasty but females have a lower rate of satisfaction with pain relief. Knee Surg Relat Res. 2020;32(1):32. doi:10.1186/s43019-020-00048-1/
26. Ritter MA, Wing JT, Berend ME, Davis KE, Meding JB. The clinical effect of gender on outcome of total knee arthroplasty. J Arthroplasty. 2008 Apr;23(3):331-6. doi: 10.1016/j.arth.2007.10.031. PMID: 18358368.
27. Parsley, B. S., Bertolusso, R., Harrington, M., Brekke, A., & Noble, P. C. (2010). Influence of gender on age of treatment with TKA and functional outcome. Clinical orthopaedics and related research, 468(7), 1759–1764. https://doi.org/10.1007/s11999-010-1348-y/
28. Teck Lim JB, Hwei Chi C, Ean Lo L. Theong Lo W, Chia SL, Yeo SJ, et al. Gender difference in outcome after total knee replacement. J. Orthop. Surg. 2015;23(2):194-197.
29. Aneja K., Machaiah PK., Bajwa S, Rudraraju RT. A multicentre retrospective study of the impact of body mass index on clinical and functional outcomes of total knee arthroplasty: An Indian prospective. J Orthop Rep. 2024; 3(3), 100308. https://doi.org/10.1016/j.jorep.2024.100308/
30. Gnaneswaran TG, Ashik MN, Dhanarajan GR., CP. Does obesity, duration of symptoms and pre-operative knee movements amend discharge readiness and outcomes following total knee arthroplasty Int J Res Orthop. 2021; 8(1), 34. https://doi.org/10.18203/issn.2455-4510.intjresorthop20214478/
31. Abbas Z, Hafeez S, Naseem A, Habib Y, Mumtaz H. Effect of body mass index on duration of total knee replacement surgery: A prospective cross-sectional study. Ann Med Surg (Lond). 2022; 82:104637.2022 Sep 23. doi: 10.1016/j.amsu.2022.104637/
32. Ayyar V, Burnett R, Coutts FJ, van der Linden ML, Mercer TH. The Influence of Obesity on Patient Reported Outcomes following Total Knee Replacement. Arthritis. 2012; 2012:185208. DOI: 10.1155/2012/185208. PMID: 23119158; PMCID: PMC3483674.
33. Ba?delio?lu K. Effects of body mass index on outcomes of total knee arthroplasty. Eur J Orthop Surg Traumatol. 2021 Apr;31(3):595-600. doi: 10.1007/s00590-020-02829-6. Epub 2020 Nov 7. PMID: 33159565.
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