Strong evidence supports that gender/sex is not associated with better or worse post-operative outcomes


Numerous studies have not found any significant difference in outcomes between men and women undergoing TSA for osteoarthritis.  Equivalent outcomes can be expected between both genders/sexes undergoing TSA for OA.  Patients can be counseled that their outcome from TSA for OA is not gender/sex specific, and that men and women can expect similar outcomes.


Strength of Evidence (quality of evidence): Strong


Benefits & Harms:

Outcome Importance: This should serve to eliminate any gender/sex-based biases towards (or against) either gender/sex in performing TSA for osteoarthritis.


Future Research:

Future studies should continue to evaluate post-operative outcomes for TSA in osteoarthritis, with one of the variables examined to include gender/sex-based differences. There has been a movement towards gender/sex specific implants.  Current data would suggest this may not be needed in the shoulder given the similar outcomes, future studies could further assess this.


Additional References:

Rasmussen, J.V., Amundsen, A., Sørensen, A.K.B., Increased use of total shoulder arthroplasty for osteoarthritis and improved patient-reported outcome in Denmark, 2006-2015: a nationwide cohort study from the Danish Shoulder Arthroplasty Registry. Acta Orthop. 2019;90(5):489-494.

Rosen, N., Chechik, O., Goldstein, Y., et. al. Trends in Shoulder Arthroplasty in Israel. Isr Med Assoc J. 2019;21(4):275-278.

Steinhaus, M.E., Gowd, A.K., Hurwit, D.J., Lieber, A.C., Liu, J.N., Return to work after shoulder arthroplasty: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2019;28(5):998-1008.

Patel, R.B., Muh, S., Okoroha, K.R., et. al. Results of total shoulder arthroplasty in patients aged 55 years or younger versus those older than 55 years: an analysis of 1135 patients with over 2 years of follow-up. J Shoulder Elbow Surg. 2019;28(5):861-868.

Gallacher, S., Williams, H..LM., King, A., Kitson, J., Smith, C.D., Thomas, W.J., Clinical and radiologic outcomes following total shoulder arthroplasty using Arthrex Eclipse stemless humeral component with minimum 2 years' follow-up. J Shoulder Elbow Surg. 2018 Dec;27(12):2191-2197.

Harjula, J.N.E., Paloneva, J., Haapakoski, J., Kukkonen, J., Äärimaa, V., Finnish Shoulder Arthroplasty Registry Group., Increasing incidence of primary shoulder arthroplasty in Finland - a nationwide registry study. BMC Musculoskelet Disord. 2018;19(1):245.

Baumgarten, K.M., Chang, P.S., Dannenbring, T.M., Foley, E.K., Does total shoulder arthroplasty improve patients' activity levels? J Shoulder Elbow Surg. 2018;27(11):1987-1995.

Merolla, G., Cerciello, S., Marenco, S., Fabbri, E., Paladini, P., Porcellini, G., Comparison of shoulder replacement to treat osteoarthritis secondary to instability surgery and primary osteoarthritis: a retrospective controlled study of patient outcomes. Int Orthop. 2018;42(9):2147-2157.

Page, R.S., Pai, V., Eng, K., Bain, G., Graves, S., Lorimer, M., Cementless versus cemented glenoid components in conventional total shoulder joint arthroplasty: analysis from the Australian Orthopaedic Association National Joint Replacement Registry. J Shoulder Elbow Surg. 2018;27(10):1859-1865.

 Mahony, G.T., Werner, B.C., Chang, B., Grawe, B.M., et. al. Risk factors for failing to achieve improvement after anatomic total shoulder arthroplasty for glenohumeral osteoarthritis. J Shoulder Elbow Surg. 2018;27(6):968-975.

Simovitch, R., Flurin, P.H., Wright, T., Zuckerman, J.D., Roche, C.P., Quantifying success after total shoulder arthroplasty: the substantial clinical benefit. J Shoulder Elbow Surg. 2018;27(5):903-911.

Getz, C.L., Kearns, K.A., Padegimas, E.M., Johnston, P.S., Lazarus, M.D., Williams, G.R. Survivorship of Hemiarthroplasty With Concentric Glenoid Reaming for Glenohumeral Arthritis in Young, Active Patients With a Biconcave Glenoid. J Am Acad Orthop Surg. 2017;25(10):715-723.

Dowdle, S.B., Glass, N., Anthony, C.A., Hettrich, C.M., Use of PROMIS for Patients Undergoing Primary Total Shoulder Arthroplasty. Orthop J Sports Med. 2017;5(9):2325967117726044.

Kilian, C.M., Press, C.M., Smith, K.M., et. al. Radiographic and clinical comparison of pegged and keeled glenoid components using modern cementing techniques: midterm results of a prospective randomized study. J Shoulder Elbow Surg. 2017;26(12):2078-2085.

Wong, S.E., Pitcher, A.A., Ding, D.Y., et. al. The effect of patient gender on outcomes after reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2017;26(11):1889-1896.

Sowa, B., Bochenek, M., Bülhoff, M., The medium- and long-term outcome of total shoulder arthroplasty for primary glenohumeral osteoarthritis in middle-aged patients. Bone Joint J. 2017;99-B(7):939-943.

Schoch, B., Werthel, J.D., Schleck, C.D., et. al. Optimizing follow-up after anatomic total shoulder arthroplasty. J Shoulder Elbow Surg. 2017;26(6):997-1002.

Leschinger, T., Raiss, P., Loew, M., Zeifang, F., Predictors of medium-term clinical outcomes after total shoulder arthroplasty. Arch Orthop Trauma Surg. 2017 Feb;137(2):187-193.

Jawa, A., Dasti, U., Brown, A., Grannatt, K., Miller, S., Gender differences in expectations and outcomes for total shoulder arthroplasty: a prospective cohort study. J Shoulder Elbow Surg. 2016;25(8):1323-7.


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