SYMPOSIUM: AAOS/ORS/ABJS MUSCULOSKELETAL HEALTHCARE DISPARITIES RESEARCH
Do We Need Gender-specific Total Joint Arthroplasty?
Aaron J. Johnson MD, Christopher R. Costa MD,
Michael A. Mont MD
Published online: 25 January 2011
? The Association of Bone and Joint Surgeons1 2011
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.
(1) What are the anatomic and mor-
phologic 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 differ-
ences in the hip been addressed, if at all, by THA?
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
The anatomic studies elucidated multiple differ-
ences in the anatomy of knees and hips between men and
women. All reviewed studies report similar clinical func-
tion 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.
Gender-specific differences in knee and hip
Current modularity in THA appears to accommodate any
anatomic differences in the hip.
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.
With more than 200,000 primary THAs and 400,000 pri-
mary TKAs performed annually, a number expected to
increase up to fivefold by the year 2030, there is a large and
growing population of patients who will have these pro-
cedures performed . Recent studies have attempted to
summarize the causes and epidemiology of revision pro-
cedures [5, 6, 39] and what can be done to minimize
clinical and radiographic failures [34, 35]. One aspect
where surgeons and patients may differ, however, lies in
the difference between a patient’s and surgeon’s definition
of a successful procedure. Two reports have suggested
nearly 40% of patients believe their expectations had not
been fully met by their total joint arthroplasty [8, 44].
Many surgeons have attempted to improve postoperative
function and to provide a more accurate restoration of
preoperative, and even predisease, anatomy. Related to
those attempts, various studies have described anatomic
differences in the hips and knees of men and women,
including altered aspect ratios in the distal femur and
proximal femur [4, 18, 24, 41], differences in Q angles
[1, 19, 50], trochlear groove dimensions , and femoral
neck and head morphology [38, 42, 51]. This work led
to some orthopaedic device manufacturers developing
‘‘gender-specific’’ total knee prostheses in an attempt to
MAM is a consultant for Stryker Orthopaedics (Mahwah, NJ) and
Wright Medical Technologies Inc (Arlington, TN) and receives
royalties from Stryker Orthopaedics. The remaining authors have no
disclosures to make. No external funding was received specifically in
support of this work.
A. J. Johnson, C. R. Costa, M. A. Mont (&)
Center for Joint Preservation and Replacement, Rubin Institute
for Advanced Orthopedics, Sinai Hospital of Baltimore,
2401 West Belvedere Avenue, Baltimore, MD 21215, USA
e-mail: email@example.com; firstname.lastname@example.org
Clin Orthop Relat Res (2011) 469:1852–1858
35. Kurtz SM, Ong KL, Schmier J, Zhao K, Mowat F, Lau E. Primary
and revision arthroplasty surgery caseloads in the United States
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36. Lavernia CJ, Alcerro JC, Contreras JS, Rossi MD. Patient Per-
ceived Outcomes After Primary Hip Arthroplasty: Does Gender
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37. Mahoney OM, Kinsey T. Overhang of the femoral component in
total knee arthroplasty: risk factors and clinical consequences.
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38. Mall G, Graw M, Gehring K, Hubig M. Determination of sex
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arthroplasty. Clin Orthop Relat Res. 2010;468:3070–3076.
40. Petterson SC, Raisis L, Bodenstab A, Snyder-Mackler L. Dis-
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41. Poilvache PL, Insall JN, Scuderi GR, Font-Rodriguez DE.
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1858 Johnson et al. Clinical Orthopaedics and Related Research1