Objective:

To investigate the influence of biological sex on postoperative outcomes following primary total hip arthroplasty (THA).

Approach:

• Study Design: A review conducted according to PRISMA guidelines, analyzing studies published from December 2015 through December 2025.
• Data Sources: Searches were performed in PubMed, Scopus, and Web of Science for studies comparing postoperative outcomes between women and men undergoing THA.
• Inclusion Criteria: Twenty-six studies involving over 2.3 million patients were included, primarily retrospective cohort or registry-based analyses.
• Outcome Assessment: Outcomes assessed included revision surgery, complications, discharge disposition, patient-reported outcomes, and functional recovery.

Key Findings:

• Women had a higher risk of revision surgery, especially younger patients and older patients with uncemented fixation.
• A national cohort reported a 2-year revision rate of approximately 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, including cardiac events and acute kidney injury.
• Optimal implant selection varied by sex and age, with cemented stems linked to lower reoperation rates in older women.

Interpretation:

Biological sex interacts with age, implant design, fixation strategy, and comorbidity burden to influence postoperative risk and recovery.

Limitations:

• 90% of studies were retrospective, with moderate risk of bias.
• Outcome definitions and follow-up periods varied significantly across studies.
• Many studies did not account for bone mineral density, hormonal status, or activity level.

Conclusion:

Sex significantly modulates postoperative outcomes following THA through complex interactions with various factors, highlighting the need for prospective studies.

Sources:

• Journal of Orthopaedics and Traumatology