Comparative analysis of postoperative outcomes in men and women following total hip replacement surgery

BACKGROUND: Total hip arthroplasty (THA) is a widely performed procedure to alleviate pain and restore function in patients with advanced hip osteoarthritis. Despite extensive research, the question of sex disparities remains inconclusive, with studies showing comparable or different clinical outcomes. METHODS: A prospective analysis was conducted on 167 patients who underwent total hip arthroplasty (THA) between 06/2022 and 06/2023 at a university hospital to analyses sex-specific outcomes. Demographic data, the mobility, the use of walking aids, pre- and postoperative range of motion, pain and the HHS (Harris Hip Score) after six months were collected and analysed. Data analyses were conducted with SPSS Version 29.0. RESULTS: The mean age of the patients was 66.9 ± 10.5 with a percentage of women (w) of 60.5%. After six months the range of motion between the sexes was significantly different with more motion deficits for men (m). For example, women revealed a significantly greater total range of motion (ranks: 70.8 vs. 92.6; p = 0.001) with a higher degree (°) of hip flexion ((w) 103.0° ± 7.5° vs. (m) 98.2° ± 7.4°; p = 0.001) and internal rotation ((w)13.3° ± 6.8° vs. (m) 8.9° ± 6.6°, p = 0.001). The pain in both sides was significantly reduced six months after surgery (rest: 2.2 ± 0.9 vs. 0.6 ± 1.5; movement: 7.3 ± 1.1 vs. 1.6 ± 2.4; for both p = 0.001) but no sex difference could be found. The gait pattern and stair climbing ability were better in men (p = 0.008; p = 0.037), but no significant differences in postoperative satisfaction or quality of life could be detected (p = 0.671; p = 0.409). The combination of a stem with a low offset and cups larger than 55 mm showed better results in the Harris Hip Score (HHS) (mean: 86.9 ± 10.7 vs. 95.3 ± 4.0; p = 0.001), what can be considered an advantage for men. CONCLUSIONS: This study shows sex differences in the range of motion and mobility in everyday life. Although the female sex showed better mobility, no differences in satisfaction or quality of life were found six months after surgery. However, the combination of stem and cup size seems to have a relevant influence on postoperative outcome, especially in men.