BENGALURU: The debate over gender differences in knee replacement surgery is moving away from implant design towards patient experience, with doctors noting that expectations from surgery remain largely the same across men and women.The shift in perspective was discussed at BOSCON 2026, the 29th annual conference of the Bangalore Orthopaedic Society, held Saturday, where clinicians highlighted that outcomes are shaped less by gender and more by when and how patients access care.“The basic question is simple—what does any patient want from a knee replacement?” said Dr Pratima Khincha, consultant orthopaedic surgeon at Khincha Orthopaedic Centre. “Pain relief, the ability to walk independently, climb stairs, return to work, and ultimately improve quality of life with as little medication as possible.” These expectations, she said, are universal.However, data shows that women often reach surgery later than men, usually with more advanced disease and greater disability. “By the time they come to us, their condition is often more advanced, and that reflects in outcomes as well,” Dr Khincha noted.A key reason is the decision-making process. Many women are not the primary decision-makers when it comes to surgery. “When patients are not the primary decision-makers, it can affect their motivation and recovery. The ideal patient is one who chooses the surgery for herself,” she said.Differences also emerge in perception. Doctors observed that women tend to be more apprehensive about post-operative pain, while men often focus on regaining pre-surgery activity levels. Both, however, share concerns about risks and existing health conditions.On implant design, Dr Shrishti Patil, consultant orthopaedic and joint replacement surgeon at SPARSH Hospital, said gender alone should not dictate choices. “Every knee is different—not just female knees,” she said. While anatomical differences exist — including issues like femoral overhang and anterior overstuffing more commonly observed in women — she noted that variability is wide across all patients. “Although gender-specific designs attempted to address this, these changes have not translated into meaningful clinical benefits,” she said.Dr Chandrashekhar C, senior joint replacement surgeon at DHEE Hospitals, said, “We don’t fail because of gender. We fail because we ignore morphology,” adding that earlier implant designs had oversimplified anatomical differences.He said the field is moving towards a phenotype-based approach, where treatment is customised to each patient’s anatomy. “This is not about male versus female implants anymore. It is about understanding each patient’s anatomy and planning accordingly,” he said.
