Patient Complications After Total Joint Arthroplasty: Does Surgeon Gender Matter?

Talia Ruth Chapman, MD; Benjamin Zmistowski, MD; Kaitlyn Votta, BS; Ayesha Abdeen, MD; James J. Purtill, MD; Antonia F. Chen, MD, MBA


J Am Acad Orthop Surg. 2020;28(22):937-944. 

In This Article

Abstract and Introduction


Introduction: Recent studies in general surgery and internal medicine have shown that female physicians may have improved morbidity and mortality compared with their male counterparts. In the field of orthopaedic surgery, little is known about the influence of surgeon gender on patient complications. This study investigates patient complications after hip and knee arthroplasty based on the gender of the treating surgeon.

Methods: Using a risk-adjusted outcomes database of 100% Medicare data from a third party, an analysis of outcomes after primary hip and knee arthroplasty based on surgeon gender was performed. This data set, which provided risk-adjusted complication rates for each surgeon performing at least 20 primary knee or hip arthroplasties from 2009 to 2013, was matched with publically available Medicare data sets to determine surgeon gender, year of graduation, area of practice, and surgical volume. Confounding variables were controlled for in multivariate analysis.

Results: Of the 8,965 surgeons with identified gender, 187 (2.0%; 187 of 8,965) were identified as women and performed 21,216 arthroplasties (1.4%; 21,216 of 1,518,419). Overall, female surgeons averaged fewer arthroplasties (total knee arthroplasty: 87.0 versus 124.9 [P < 0.001]; total hip arthroplasty [THA]: 62.8 versus 78.8 [P = 0.02]) and were earlier in their practice (20.6 versus 25.0 years; P < 0.001) compared with their male counterparts. Male and female surgeons had similar adjusted complication rates for THA (2.78% versus 2.84%) and total knee arthroplasty (2.24% versus 2.26%). Multivariate analysis found that the predictors of increased complications were decreased surgeon volume, THA, increased surgeons' years in practice, and geographic region.

Discussion: Overall, female orthopaedic surgeons performed fewer arthroplasties and were earlier in their career. This, however, did not a have a negative impact on their surgical outcomes. Rather, complication rates were dependent on surgeon volume, surgeon experience, and region.

Level of Evidence: Level III–prognostic retrospective case-control study.


Since the 1970s, the number of women pursuing careers in medicine has steadily increased.[1] The increase in the percentage of women in orthopaedics over the past 40 years has been markedly lower than those in every other specialty; however, recent studies have demonstrated an increasing proportion of female orthopaedic surgeons.[1,2] In 1970, only 0.6% of orthopaedic surgery residents were women but in 2013, that number grew to 13.8%.[1,3] It is hoped that this increase in women choosing a career in orthopaedics will help meet the expected increased demand for orthopaedic surgeons nationwide.[4]

Little is known, however, about the influence of surgeon gender on patient complications. One recent study in the medical field found that elderly hospitalized patients treated by female internists had lower mortality and readmissions compared with those cared for by male internists.[5] Another study assessed physician gender-based outcomes after surgical procedures.[6] Patients undergoing one of 25 surgical procedures performed by a female surgeon were matched to patients undergoing the same operation by a male surgeon, and female surgeons were found to have a significant decrease in 30-day mortality and similar surgical complications after accounting for patient, surgeon, and hospital characteristics.

Although it has often been assumed that orthopaedic surgeons must be physically strong and men are potentially better suited for this, especially to perform lower extremity joint arthroplasty, the true impact of surgeon gender on patient complications after elective orthopaedic surgery is unknown.[7,8] As the female workforce in orthopaedics increases, it is important to assess the impact that this demographic shift will have on patient outcomes. Many of these young surgeons are likely to fill the expected void in the demand for arthroplasty surgeons.[9] Given the notable annual volume of this reproducible procedure, research has been dedicated to factors affecting total joint arthroplasty (TJA) outcomes[10–13]—repeatedly showing that increased surgeon volume, hospital volume, and procedure standardization lead to decreased patient complications. Furthermore, the reproducibility of these procedures provides an opportunity for assessing the impact of surgeon gender on patient complications. Therefore, this study aims to use well-established databases to assess the impact of surgeon gender, among other factors, on early postoperative complications after elective TJA.