What’s with orthopedists and women? A survey published in Pain Medicine News, for May, reports that orthopedists recommended total knee replacements much more often to men than they did to women. A Yale rheumatologist and her associates conducted the survey of 406 orthopedic surgeons and 494 rheumatologists.
Gender Bias in Orthopedics?
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The investigators presented each doctor with the case of a 62-year-old individual with osteoarthritis of the knee and moderate pain. The details varied. The patient was sometimes male, sometimes female, sometimes retired and sometimes working. The severity of the osteoarthritis varied from mild to moderate.
Of the orthopedic surgeons, 59% recommended knee replacement when the patient was male and 44% when the patient was female. Among rheumatologists, there was no significant difference in recommendations for male or female patients, although rheumatologists in an academic setting were far more likely to suggest knee replacement than those who were in a non-academic setting (63% to 48%). The Arthritis Foundation and the National Institute of Arthritis and Musculoskeletal and Skin Diseases funded the research.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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