Study Reveals Hip Replacements More Likely to Fail in Women

So many Americans who suffer from severe hip pain or loss of mobility opt for surgery. An estimated 400,000 hip replacement surgeries are performed annually, the majority of which are women. However, new research shows women were 29 percent more likely than men to need a repeat surgery within the first three years.

The failure rate for women was almost twice as high than for men from the use of metal-on-metal hips. Some believe this is due to the fact that women are built differently than men. However, one doctor told FOX 9 News that the study reveals an essential need to look at the individual and what best suits each patient.

Many women who have hip replacement surgery performed do not achieve any improvement and still experience severe pain, causing them to consider a repeat surgery.

Heidi White initially opted for hip replacement surgery so she would be able to go to the park with her young children without constant aching hip pain. After her initial hip replacement procedure, she said, “The first time, it never got better. It was super miserable the entire time.”

Three weeks ago, she repeated the surgery with the hopes that the problem would finally be corrected.

White is part of the statistic in the study, given that her first replacement failed within three years.

“There is some concern from the registry data that women are having a little bit more of a problem than men early on, and we need to figure out why that is,” said Dr. Scott Anseth, director of the Joint Replacement Center at Abbot Northwestern Hospital. “There is a real importance of getting it right the first time in hip replacement.”

Anseth said that female patients are more challenging because they tend to have smaller joints and bones and require smaller artificial hips.

Devices with smaller femoral heads (the ball-shaped part of the ball-and-socket joint in an artificial hip) are more likely to dislocate and require surgical repair.

“What we know is that the smaller balls tend to dislocate, so positioning appropriately is a very significant part of preventing it,” he explained. “So, that’s a challenge to women.”

Although Anseth wants patients to remember that hip replacement is one of the most successful surgeries in modern medicine, with a 98 percent success rate, the study still raises many questions, such as which model of implant performs best in women.

“This is the first step in what has to be a much longer-term research strategy to figure out why women have worse experiences, said Diana Zuckerman, president of the nonprofit National Research Center for Women & Families.

“Research in this area could save billions of dollars” and prevent patients from experiencing pain and inconvenience of surgeries to fix hip implants that went wrong.

Researchers looked at more than 35,000 surgeries at 46 hospitals in the Kaiser Permanente health system. This research was published Monday in JAMA Internal Medicine, and was funded by the U.S. Food and Drug Administration.

After an average of three years, 2.3 percent of the women and 1.9 percent of the men had undergone revision surgery to fix a problem with the original hip replacement.  The problems included instability, infection, broken bones and loosening.

“There is an increased risk of failure in women compared to men,” said lead author Maria Inacio, an epidemiologist at Southern California Permanente Medical Group in San Diego. “This is still a very small number of failures.”

Co-author Dr. Monti Khatod, an orthopedic surgeon in Los Angeles, speculated that one factor might be a greater loss of bone density in women.

The failure of metal-on-metal hips was almost twice as high for women than men. Although they were once popular as promoted by manufacturers as being more durable than ceramic or plastic joints, many recalls have led to their decreased use in the last few years.

“Don’t be fooled by hype about a new hip product,” said Zuckerman, who wrote an accompanying commentary in the medical journal. “I would not choose the latest, greatest hip implant if I were a women patient…At least if it’s been for sale for a few years, there’s more evidence for how well it’s working.”

It seems that if there are this many problems affecting hip replacements in women, maybe they should offer several sizes based on the female patient’s size before surgical placement is done.  Patients should be warned prior to surgery that revision or additional surgeries might be necessary, as the 29 percent of women have found after their failed hip replacement surgeries.

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