Gender Influences on Shoulder Arthroplasty

These authors reviewed the recent literature regarding the influence of "gender" on shoulder arthroplasty. They found that while both female and male patients generally benefit from shoulder arthroplasty, several differences may existbin preoperative factors, acute perioperative complications, and postoperative outcomes.

Female patients were found to

undergo shoulder arthroplasty at an older age,

have greater levels of preoperative disability and

have different preoperative expectations.

Perioperatively, female patients may be at increased risk of

extended length of stay,

postoperative thromboembolic events, and

blood transfusion.

Postoperatively, female patients may achieve

lower postoperative functional scores and

decreased range of motion.

Finally, female patients may be at greater risk for

periprosthetic fracture and

aseptic loosening

while having a lower risk for

periprosthetic infection and

revision surgery.

Comment: In considering these findings, it is important to distinguish sex and gender (the term used by the authors of this article). According to Sex and gender: What is the difference?: “Sex” refers to the physical differences between people who are male, female, or intersex. A person typically has their sex assigned at birth based on physiological characteristics, including their genitalia and chromosome composition. This assigned sex is called a person’s “natal sex.” Gender, on the other hand, involves how a person identifies. Unlike natal sex, gender is not made up of binary forms: instead there is a broad spectrum of genders (a glossary of terms relating to gender may be found in this link).

Most orthopaedic studies comparing male and female patients, such as that presented above, are studies of the effect of sex, rather than gender.

Consider, for example, the chart below from "The “tipping point” for 931 elective shoulder arthroplasties (see this link)." This graph shows a clear difference between the tipping point for elective arthroplasty between patients of male and female sex. Female patients coming to shoulder arthroplasty had worse preoperative self-assessed shoulder comfort and function.

Consider also the effect of patient sex on arthritic glenohumeral anatomy as investigated in Prearthroplasty glenohumeral pathoanatomy and its relationship to patient’s sex, age, diagnosis, and self-assessed shoulder comfort and function.

Patient sex had a strong effect on the distribution of glenoid types.

and on glenoid version

and on the degree of decentering

The chart below is from Factors Affecting Length of Stay, Readmission, and Revision after Shoulder Arthroplasty, showing the effect of patient sex on length of stay.

In, Correlates with comfort and function after total shoulder arthroplasty for degenerative joint disease, the strongest correlates with postoperative shoulder function included male sex (P<0001), and preoperative physical function (P <0001), social function (P <0001), mental health (P <0001) and shoulder function (P <0001).

Gender identification was not assessed in the studies above.

Rather than focusing on patient sex alone, medical systems are now paying deserved attention to patient gender and documenting some of the important information in the medical record.

As the importance of gender identification is being recognized and documented in medical records, future studies of patients having shoulder arthroplasty are likely to identify differences - not only between the sexes, but also among genders - in preoperative characteristics (height, weight, age, disability, expectations), tipping point for surgery, type of surgery elected, complications and outcomes.

Finally as emphasized in Equity360: Gender, Race, and Ethnicity—Title IX Turns 50:

Women Athletes Are Still Fighting Against Gender Disparities in Sports, transgender individuals may augment or suppress their sex hormone levels which, in turn, may affect bone density and periprosthetic fracture risk as well as the risk of infection after shoulder arthroplasty. See