Women Do Have Hip Replacements More Frequently Than Men
Yes, it is true that women undergo total hip replacement surgery more frequently than men, though the difference is modest and varies by age. 1
Hip Fracture Risk vs. Hip Replacement Rates
The relationship between hip fractures and hip replacements reveals important sex differences:
Hip Fracture Incidence
The risk of hip fractures is greater in women than in men, but this gap narrows substantially with advancing age 1. The Dubbo Osteoporosis Epidemiology Study demonstrated that the female-to-male hip fracture ratio was:
- 1:4.5 at ages 60-69 years
- 1:1.5 at ages 70-79 years
- 1:1.9 at ages ≥80 years 1
This means women have 4.5 times more hip fractures than men in their 60s, but by age 70-79, women only have 1.5 times more fractures.
Hip Replacement Utilization
Women receive total hip replacement at rates 3-6 times higher than revision hip replacement, and women consistently undergo more primary hip replacements than men 2. In the U.S. Medicare population (ages ≥65), women had higher rates of primary total hip replacement than men 2.
However, the lifetime risk of hip replacement is remarkably similar between sexes when mortality is adjusted—approximately 10% for both men and women by ages 20-29 3. For women, lifetime risk increased from 8.49% (1999-2000) to 10.30% (2007-2008), while for men it rose from 9.29% to 10.27% before declining slightly to 9.90% 3.
The Paradox: Higher Disease Burden, Similar Utilization
Despite women having a higher prevalence of hip osteoarthritis and reporting worse symptoms, they undergo hip replacement at rates only modestly higher than men—a finding that suggests potential underutilization in women 4, 5.
A Canadian study found that women had 1.76 times higher prevalence of hip arthritis and worse symptoms/disability, yet were less likely to have undergone arthroplasty (odds ratio 0.78) and less likely to have discussed surgery with a physician (odds ratio 0.63) despite equal willingness to undergo the procedure 5. The potential need for hip arthroplasty was 44.9 per 1000 women versus 20.8 per 1000 men, but after adjusting for willingness, the numbers were 5.3 per 1000 for women and 1.6 per 1000 for men—revealing underuse in both sexes, but more than three times greater underuse in women 5.
Gender-Based Barriers and Disparities
Recent qualitative research reveals important gender differences in surgical decision-making 4:
Men reported:
- Concerns about hobbies and recovery support
- Feeling encouraged to pursue surgical treatment
Women reported:
- Prioritizing household responsibilities over their own health
- Greater concern about cosmetic outcomes
- Trialing alternative treatments more extensively before considering surgery
- Perceiving age- and gender-based biases in their care 4
Clinical Implications
When counseling patients about hip replacement:
- Recognize that women may face implicit barriers to accessing hip replacement despite having equal or greater need
- Actively discuss surgical options with female patients who have severe hip arthritis, as they are less likely to have these conversations initiated
- Address gender-specific concerns including household responsibilities, cosmetic outcomes, and recovery support
- Be aware that women may exhaust conservative treatments longer than necessary before considering surgery
- Consider that similar lifetime risk between sexes masks potential underutilization in women given their higher disease burden
The evidence clearly shows women undergo hip replacement more frequently in absolute numbers, but when adjusted for disease burden and need, women are actually undertreated relative to men—a critical disparity that clinicians must actively address 4, 5.