Sex-based differences in hip replacement outcomes

A systematic review of more than 2.3 million patients found that women and men had different patterns of postoperative complications and recovery, with age and implant strategy modifying observed differences.

By
Andrea Surnit
August 21, 2026
4 min

MDSpire News

Overview

This review examines the influence of biological sex on postoperative outcomes following total hip arthroplasty (THA). Findings indicate that women face a higher risk of revision surgery and surgical complications compared to men, particularly in younger and older populations receiving uncemented fixation.

Background

Understanding sex-based differences in hip replacement outcomes is crucial. With an increasing number of patients undergoing THA, recognizing how biological sex interacts with factors like age and implant choice is essential.

Data Highlights

The review included 26 studies with over 2.3 million patients, highlighting differences in outcomes based on sex.

Key Findings

Women had a higher risk of revision surgery, particularly among those younger than 55 years.
A national cohort reported a 2-year revision rate of 3% in women compared to 2% in men.
Women experienced higher rates of surgical complications, including periprosthetic femoral fracture and surgical site infection.
Men had higher rates of early medical complications, such as cardiac events and acute kidney injury.
Older women with uncemented THA had increased risks of periprosthetic fracture compared to those with cemented stems.
Long-term functional outcomes were similar between sexes, with differences primarily noted in the early postoperative period.