Gender Disparities in Joint Replacement

October 16, 2012

Women have a longer life expectancy compared to men. Women are also more likely than men to develop arthritis. However, joint replacement is significantly underutilized by women. Women typically undergo joint replacement at an older age than men. When they do finally have surgery, women typically have higher pain scores and lower functional scores than their male counterparts, indicating that their arthritis is worse when they finally have surgery. The outcome of surgery in men and women, however, is equivalent.

Why do women put off having hip or knee replacement surgery? I find many women with severe arthritis have simply found ways to deal with the discomfort while they have been focused on taking care of their husbands, children, or grandchildren. Other women are widowed, live alone, and worry that they will have no one to help care for them as they recover from surgery. When contemplating having surgery, women are more likely to ask questions about the indications for surgery, drawbacks, and recuperation. Men are less likely to ask questions and often focus on the implants and surgical technique. Finally, some women feel intimidated by male physicians. There are not very many female orthopaedic surgeons. Less than 5% of board certified orthpaedic surgeons are women, and even fewer women are fellowship trained in joint replacement surgery.

When is it time to have joint replacement surgery? How much pain should you have, how functionally impaired should you be, before deciding to have surgery? There is no evidence-based answer to this question. An interesting study from Canada found that both primary care and orthopaedic surgeons were four times less likely to refer a female patient with moderate arthritis for surgery compared to a male patient with identical radiographs. I tell my patients that you should not have joint replacement surgery unless you have severe arthritis, have failed non operative treatment, and have pain that interferes with your ability to enjoy your life. But even this is somewhat subjective, as everyone has a different ability to tolerate pain. There are many treatments for arthritis, and not all of them involve surgery. Don’t be afraid to talk to your physician about your arthritis pain. Sometimes you have to stop taking care of everyone else and address your own health care needs.