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Sex Matters: Investigating the Influence of Presurgery Factors on Pain and
Physical Function following Total Joint Arthroplasty for Osteoarthritis
#MMPMID41185850
Perruccio AV
; Power JD
; Sundararajan K
; Canizares M
; Davey JR
; Gandhi R
; Syed K
; Veillette C
; Kapoor M
; Mahomed NN
; Rampersaud YR
JB JS Open Access
2025[Oct]; 10
(4
): ? PMID41185850
show ga
BACKGROUND: Despite broad calls to consider sex-specific effects in
treatment/intervention studies, this remains a persistent gap. This study sought
to identify presurgery factors associated with pain and physical function
following hip and knee total joint arthroplasty (TJA) for osteoarthritis,
specifically adopting a sex-stratified approach. METHODS: Questionnaires were
patient-completed presurgery: sociodemographic and health-related
characteristics, anxiety and depression symptoms, neuropathic-like pain symptoms,
multijoint involvement, and opioid use. Pain and physical function were captured
presurgery and 1 year postsurgery. Study outcomes: pain and function status
scores at 1 year and their percentage change (presurgery to 1 year postsurgery).
Associations between presurgery factors and outcomes were assessed by
sex-stratified multivariable linear regressions. Findings were contrasted against
a sex-adjusted approach (i.e. one analysis in combined male/female sample).
RESULTS: Sample (45% hip, 55% knee): 787 female patients and 640 male patients.
Among male patients only: Depressive symptoms were associated with worse pain and
function status, and less pain improvement (? = -8.6% [-17.4%, 0.3%]), as were
lower education and living alone. Among female patients only: Anxiety symptoms
were associated with worse pain and function status and less pain (? = -7.7%
[-14.3%, -1.0%) and functional improvement (? = -8.5% [-14.4%, -2.6%]), as was
greater multijoint burden. The negative effect of neuropathic-like pain symptoms
was greater in male patients than female patients. Sex-adjusted findings
suggested sex had no consequence. CONCLUSIONS: Several factors uniquely
influenced TJA outcomes by sex. Simple sex-adjustment may miss important effects.
This has broad implications, including for patient education, decision making,
prognostic/comparative effectiveness study design, and development/improvement of
prediction algorithms. Though TJA focused, we hypothesize that sex differences
are likely relevant in other clinical populations. LEVEL OF EVIDENCE: Prognostic
Level I. See Instructions for Authors for a complete description of levels of
evidence.
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