Influence of sex on surgical time in primary total knee arthroplasty

Background: Total knee arthroplasty (TKA) is widely recognized as an effective procedure for treatment of knee arthritis. However, there have been documented differences between men and women with respect to anatomic variability, timing of access to surgical care and surgical outcomes. We examined the influence of sex on the technical difficulty of TKA using a tourniquet and overall surgical time as a surrogate for complexity of exposure, soft-tissue balancing and implantation. Methods: We performed a retrospective database review of patients who underwent primary TKA over a 5-year period. Tourniquet time, wound closure time and surgical time from 54 consecutive men (58 knees) and 48 women (58 knees) who underwent primary cemented TKA were recorded. Results: The mean surgical time among men (108.2, standard deviation [SD] in min) was significantly longer than among women (96.8 [SD 14.8] min; p = 0.001). Similarly, the mean tourniquet time among men (75.9 [SD 11.7] min) was significantly longer than among women (65.9 [SD 11.8] min; p = 0.001). Conclusion: Total knee arthroplasty in men requires more time than in women because of the complexity of exposure and to achieve the desired alignment of the components. Our data may allow a better resolution of surgery time planning, which could lead to better use of health system resources.