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The major indication for total hip arthroplasty (THA) is pain and disability in the hip. Evidence from state and local studies suggests that women may be more disabled than men at the time of THA. Whether worse disability at the time to THA affects outcomes is unknown.To examine differences in functional status and pain in men and women at the time of THA and at 1 year in a nationally representative Medicare population.Cohort of patients undergoing THA. Data were collected at the time of THA, 4 to 6 months after surgery, and 1 year after surgery.All Medicare recipients older than age 65 in 12 selected states were eligible.One thousand six hundred forty patients who underwent THA were identified and 1120 (432 men and 688 women) were enrolled.Pain and functional status.At the time of THA, women were more likely than men to report severe pain with walking (67% vs. 58%;P <0.01), and needing assistance with walking (56% vs. 45%;P <0.01), housework (49% vs. 30%;P <0.01), and grocery shopping (51% vs. 31%;P <0.01). Men could also walk greater distances. These differences persisted after adjustment for comorbidities and age. One year following THA, women were more likely to report needing assistance with walking (30% vs. 21%;P <0.01), housework (29% vs. 23%;P <01), and grocery shopping (27% vs. 19%;P <0.01) and could walk shorter distances. These differences were partially accounted for by differences in comorbidities and baseline status.Compared with men, women in Medicare are more disabled at the time of THA and do not do as well at 1 year. Whether this difference arises from patients’ preferences or bias in the health care system is unknown.