TORONTO, Ontario, Canada—Sure, there may be joint implants made especially for women, but doctors are still more likely to recommend total knee arthroplasty to male patients than female patients, according to a new study in the March 11th edition of the Canadian Medical Association Journal.¹

"Acknowledging that a gender bias may affect physician's decision-making is the first step toward ensuring that women receive complete and equal access to total joint arthroplasty" conclude researchers led by Cornelia Borkhoff, PhD of The Hospital for Sick Children in Toronto, Ontario, Canada. "The next step is to develop creative interventions to address these disparities in health care."

The researchers used 1 male and 1 female patient with moderate knee osteoarthritis (OA) who had the same symptoms and were coached on how best to describe them. These patients were examined by 67 physicians (38 family physicians and 29 orthopaedic surgeons).

Physicians were twice as likely to recommend total knee arthroplasty to the male patient than to the female patient, the study showed. Overall, 67% of physicians recommended total knee arthroplasty to the male patient compared with 33% who recommended it to the female patient.

The researchers speculate that gender bias on the part of the doctors account for the new findings. "Our findings suggest that physicians are prone to the same automatic, unconscious, and ubiquitous social stereotyping that affect all of our behavior," the researchers write.

He said, she said

This problem has a simple solution, said Phyllis E. Greenberger, MSW, president and CEO of the Society for Women’s Health Research (SWHR), a Washington, DC-based advocacy group that fosters research into women's health. "Recognize that these conditions occur in both men and women, and take them as seriously in women as you do in men."

In general, women are not being recommended for joint replacement surgery as early as are men, she said. As a result, they wait too long, and in some cases, their results are not as positive and their recuperation period is more difficult.

"Doctors need to take women's complaints as seriously as they do men's." While female patients can advocate for themselves, Greenberger said, “nobody will ask for surgery, so the doctor has to make it clear [to the patient] that [arthroplasty] is indicated and it will eliminate their suffering," she said. "If they don't, women will go home and come back later when their [knee OA] is worse."

Gender disparity is a big issue in orthopaedics, agreed Laura Tosi, MD, orthopaedic surgeon at Children's National Medical Center in Washington, DC, immediate past chair of the women's health issues committee for the American Academy of Orthopaedic Surgeons, and member of the SWHR board of directors.

It may be a bias on the part of doctors, but women's dispositions can also play a role, she said.

"Is there a prejudice by surgeons or are there behavioral characteristics in us…that mitigate against women getting the surgery?" Dr. Tosi asked. "Women…frequently put their family first. Yes, their knee is aching, so they take more Advil or Alleve and keep on because they feel their families need them …," she said.

And this is particularly unfortunate when it comes to knee OA. "…men tend to get arthritis of the hip and women tend to be far more disabled by arthritis of the knee, so it is particularly important that women with knee OA are heard," she continued. "If women really need total knee arthroplasty, we want them to get it."

Reference

Borkhoff CM, Hawker GA, Kreder HJ, et al. The effect of patients' sex on physicians' recommendations for total knee arthroplasty. Can Med Assoc J. 2008;6:681-687.