The role of gender differences in tissue biophysical properties in osteoarthritis progression

Objectives This study investigates gender differences in primary hip osteoarthritis (OA) progression through a prospective observational approach, analyzing functional, radiographic, and biophysical disparities between male and female patients. The findings aim to enhance patient treatment and management from clinical and biomechanical perspectives. Materials and Methods Patients undergoing total hip arthroplasty (THA) due to primary hip OA were divided into two cohorts based on gender. Preoperative evaluations included functional disability assessment and standard hip and pelvis X-rays graded by the Tönnis classification. During surgery, femoral heads were preserved for microstructural analysis. A subset (13 males, 12 females) underwent micro-computed tomography to assess bone volume fraction, porosity, trabecular thickness, and separation. Follow-ups at 6 and 12 months included postoperative X-rays and functional assessments. Results Both cohorts showed significant functional improvement postoperatively, consistent with literature. Return-to-work time ranged from 4 to 12 weeks, averaging 6 weeks. Statistically significant gender differences emerged in postoperative Harris Hip Score (HHS) and WOMAC scores at both follow-ups, as well as return-to-work time. Preoperatively, the HHS also showed a less pronounced difference. Analysis of 125 femoral head specimens revealed no significant gender differences in bone mineral density or bone volume fraction. However, trabecular anisotropy, thickness, and separation differed significantly. Correlation analysis indicated moderate preoperative associations between bone mineral density, anisotropy degree, and clinical scores, but these weakened postoperatively. Laboratory findings did not strongly correlate with clinical outcomes at 6 or 12 months. Conclusions While no significant gender disparities in clinical outcomes were identified, differences in microstructural tissue characteristics suggest the need for gender-specific considerations in managing end-stage OA. This study provides a rigorous and replicable framework for investigating osteoarthritis progression.