Patient gender may influence the referral and recommendation process for total joint arthroplasty.
“Although age-adjusted rates of total joint arthroplasty (TJA) are higher for women than men, a Canadian population-based study found that underuse of TJA among willing and appropriate candidates is more than 3 times greater in women than men,” said Cornelia Borkhoff, PhD, of the Canadian Osteoarthritis Research Program at Women’s College Hospital in Toronto, Canada. Dr. Borkhoff was a featured speaker at the recent AAOS/Orthopaedic Research Society/American Bone and Joint Surgeons sponsored research symposium on Musculoskeletal Health Care Disparities.
The first step occurs when patients recognize they have a treatable medical condition, said Dr. Borkhoff.
Another factor that may affect a physician’s referral patterns is the way patients describe their symptoms.
At step 6, the patient reports symptoms of chronic knee pain or hip pain to the orthopedist, who determines whether the patient is a candidate for surgery.
According to Dr. Borkhoff, interventions to address the disparity in TJA usage among women are needed.
- Even though women are just as likely as men to seek treatment for osteoarthritis, physicians are less likely to recommend total joint arthroplasty (TJA) to a woman than to a man.
- How physicians respond to male and female patients during the referral and recommendation process may affect a woman’s odds of undergoing TJA.
- More training for physicians in culturally competent care and shared decision-making may reduce this disparity.
- Borkhoff CM, Hawker GA, Kreder HJ, Glazier RH, Mahomed NN, Wright JG: The effect of patients’ sex on physicians’ recommendations for total knee arthroplasty. CMAJ, 2008;178(6):681-687.
- Hawker GA, Wright JG, Coyte PC, et al: Differences between men and women in the rate of use of hip and knee arthroplasty. N Engl J Med, 2000;342(14):1016-1022.
- Stacey D, Hawker G, Dervin G, et al: Management of chronic pain: Improving shared decision making in osteoarthritis. BMJ, 2008;336:954-955.
July 2010 Issue