The Use of Hip and Knee Joint Replacement is Lower in Women Compared to Men
In a recently published study (N Engl J Med 342:1016-22, 2000), Hawker, et al sought to determine whether there were differences between men and women in the potential need and willingness to undergo knee and hip joint replacement (arthroplasty). The study consisted of 3 phases (see table) and was conducted within two areas (East York and Oxford County) of Ontario, Canada. Respondents from phase I were selected for phase II if they had at least moderately severe arthritis defined by their responses on the questionnaire. Participants in phase II having a WOMAC score of > 39 and a random sample of persons with scores of 7 to 38 were asked to participate in phase III.
|Number of Participants||Method of Evaluation|
|Phase I||28,451||a questionnaire to identify joints with symptoms, report specific functional disabilities, state whether they has undergone arthroplasty|
|Phase II||2411||three questionnaires; the Western Ontario McMaster Univeristy Osteoarthritis Index (WOMAC), the 36-item Short Form Health Survey, and the disability subscale of the Health Assessment Questionnaire|
|Phase III||1325||a standardized joint examination; anteroposterior radiographs of the pelvis; anteroposterior and lateral radiographs of the knees while standing|
Adjusted odds ratio from phase I results found that women were less likely than men to have undergone arthroplasty (0.78; 95% confidence interval, 0.72-0.90). Results from phase III showed that 990 of the 1325 participants demonstrated a potential need for arthroplasty (5.3 per 1000 women from phase I and 1.6 per 1000 men from phase I). Of these, the women were less likely than men to report having ever discussed arthroplasty with a physician (0.63 adjusted odds ratio, P=0.01), even though they found no differences in their willingness to undergo arthroplasty after adjustment for disease severity and coexisting conditions.
This study demonstrates that although there is an underuse of arthroplasty in cases of severe arthritis in both men and women, the degree of underuse in women is three times greater than it is for men.