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

At a Glance

Category	Detail
Condition	Total Hip Arthroplasty (THA)
Key Mechanisms	Biological sex interacts with age, implant design, fixation strategy, and comorbidity burden to influence postoperative outcomes.
Target Population	Patients undergoing primary total hip arthroplasty, particularly women and men of varying ages.
Care Setting	Orthopedic surgery and postoperative care

Key Highlights

Women had a higher risk of revision surgery, especially younger patients and those with uncemented fixation.
Men experienced higher rates of early medical complications post-THA.
Optimal implant selection may differ by sex and age.
Women reported greater improvements in pain relief and mental quality of life.
Long-term functional outcomes were similar between sexes.

Guideline-Based Recommendations

Diagnosis

Consider biological sex as a factor in assessing postoperative outcomes.

Management

Tailor implant selection and fixation strategy based on patient sex and age.

Monitoring & Follow-up

Monitor for specific complications based on sex, age, and implant type.

Risks

Be aware of the higher risk of surgical complications in women and early medical complications in men.

Patient & Prescribing Data

Patients undergoing primary total hip arthroplasty, with attention to sex and age differences.

Cemented stems may reduce reoperation rates in older women, while cementless collared stems may benefit older men.

Clinical Best Practices

Utilize a multidisciplinary approach to assess comorbidities and optimize surgical outcomes.
Encourage prospective studies to further explore the mechanisms of sex-based differences.