DePuy Synthes Takes the Measure of OA on Women’s Lives

Knee and hip pain and deteriorating function damage the quality of life far beyond mobility say 76% of women in a Depuy Synthes survey, released August 20, 2018.

The survey is a new part of a Depuy Synthes campaign begun in 2016, called “Hit Play,”, aimed at educating women ages 45-65 on how joint pain affects their well-being and encourages them to “Hit Play” (that is, ask their doctors about treatment options).

The Focus on Women

Why survey only women?

“[T]hese women are the heroines of their households, often considered the ‘Irreplaceable Woman.’ By identifying and addressing how hip and knee pain impacts the Irreplaceable Woman beyond her mobility and understanding the emotional triggers associated with deciding on joint replacement surgery, we are able to help educate women to speak to their doctor sooner,” said John Wright, M.D., Integrated Leader Medical, Clinical and Pre-Clinical Affairs at DePuy Synthes and former Clinical Director of Orthopedic Surgery at Brigham and Women’s Hospital, Boston, Massachusetts, in an emailed response to our question.

“By shining a spotlight on the mental, emotional, and interpersonal struggles of those experiencing hip or knee pain we aim to help women understand…that seeking treatment can help holistically improve their lives.”

Another reason for focusing on women, not cited by Depuy Synthes, is that published studies have concluded that many more women than men are candidates for knee surgery and about as many women as men are candidates for hip arthroplasty, but fewer women choose either surgery, and they tend to wait longer, until the pain is worse:

“Women are more likely than men to suffer from osteoarthritis, and women experience more severe arthritis in the knee…. Although the presentation of osteoarthritis does not differ between men and women, symptom severity does. Additionally, women are three times less likely than men to undergo hip or knee arthroplasty.” – Journal of the AAOS, “Sex Differences in Osteoarthritis of the Hip and Knee,” by Mary I. O’Connor M.D., who was then Associate Professor of Orthopedics and Chair of the Department of Orthopedic Surgery at Mayo Clinic in Jacksonville, Florida. Dr. O’Connor is now Director of the Center for Musculoskeletal Care at Yale School of Medicine and Yale-New Haven Health, New Haven, Connecticut.

“There is underuse of arthroplasty for severe arthritis in both sexes, but the degree of underuse is more than three times as great in women as in men,” according to a study, “Differences between Men and Women in the Rate of Use of Hip and Knee Arthroplasty,” New England Journal of Medicine, April 6, 2000.

“Women have a higher incidence of inflammatory arthritis like Rheumatism (actually nearly 9:1),” according to an April 21, 2015 article, “Gender Differences in Joint Replacement,” by Brett Greenky. M.D. and Seth Greenky, M.D., of Syracuse Orthopedics Specialists, with offices around Syracuse, New York.

Depuy Synthes says the negative effects for women go far beyond mobility:

• 90% say they can’t live life to the fullest because of their joint pain.
• 90% say their joint pain negatively impacts their mood.
• Two-thirds have avoided a social situation because of joint pain.
• More than 50% said joint pain makes it personally challenging to feel they’re part of their families.
• After surgery, 89% feel like they can participate in life again.
• Two-thirds of those who had the surgery say their relationship with their spouse or partner improved.
• 60% report improved intimacy after surgery.

The Depuy Synthes news release quotes their consultant in joint reconstructon Anna Kulidjian, M.D., MSC, FRCSC, Associate Clinical Professor, Joint Reconstruction and Limb Preservation, Program Director Orthopaedic Oncology at Scripps Clinic-Green Hospital, San Diego, California:

“In my practice, I talk daily with women experiencing knee and hip pain who feel like they are living their life on the sidelines. The women surveyed are in the prime of their life yet have a heavy emotional cloud over them because they aren’t living the life they want, due to their hip and knee pain.”

Dr. O’Connor’s article seems to support the idea behind the Depuy Synthes initiative: “Patient education, particularly for women, must be improved so that women with osteoarthritis who are candidates for hip and knee arthroplasty not only receive treatment but also receive it in a timely manner.”

Why Do Women Avoid or Delay Surgery?

The answer Depuy Synthes sent us from Dr. Wright said in part:

“…[W]omen surveyed cited may barriers…including a belief that surgery is a last resort option, as well as misperceptions of the length and difficultly of the recovery period.”

Women tend to believe before surgery that their risks are higher than for men, but the opposite is statistically true, said a study led by Bheeshma Ravi, M.D., Ph.D. of the University of Toronto, covered in an Orthopedics This Week article, “Study Refutes Gender Differences Data” by Biloine W. Young, Wed, April 29th, 2015.

Also, are surgeons partially to blame for the gender gap? Another Biloine W. Young article, “Gender Bias in Orthopedics,” in the July 13, 2013 issue, cited a study funded by the Arthritis Foundation and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, which asked orthopedists to recommend treatment for a theoretical 62-year-old patient with osteoarthritis of the knee and moderate pain. “Of the orthopedic surgeons, 59% recommended knee replacement when the patient was male and 44% when the patient was female,” the article said.

And Are Horror Stories a Significant Factor?

Is it possible that women are more likely than men to pay attention to the horror stories widely published by law firms trolling for malpractice clients? The stories are easy enough to find. Just Google “hip replacement horror stories” and “knee replacement horror stories,” and you could have a full day’s reading ahead of you.

One site which ranks high in searches is drugwatch.com, which describes itself as, “Help for people injured by defective drugs and medical devices. Drugwatch provides information on high-risk medical products and health issues, and helps people take legal action if they’ve been injured.”

The site is funded by a law firm, Wilson and Peterson, LLP. Its articles on adverse outcomes seem to be quite factual—and scary. Drugwatch publishes about exceptions, not the rule. However. it’s easy to see, reading its stories, how a casual reader might conclude that a bad outcome in one case might be taken as representing reality generally.