Although women are three times more likely than men to have severe arthritis which would benefit from joint replacement, they are less likely to have ever discussed the surgical procedure with their doctors, according to a study published in the April 6 edition of the New England Journal of Medicine.
The study also found women experience worse symptoms and suffer greater disability due to arthritis yet are less likely to undergo joint replacement surgery, or arthroplasty. "Joint replacements have been shown to significantly reduce pain, increase physical function and therefore improve quality of life," says the study's lead author, Dr. Gillian Hawker, director of the clinical epidemiology program in the University of Toronto's Faculty of Medicine and a rheumatologist at Sunnybrook and Women's College Health Sciences Centre. "Women are receiving too few of these replacements. We need to find out why."
Previous studies have found similar results with life-saving surgeries like kidney transplants and coronary bypass, but this is the first time researchers have examined an elective surgery. "I believe this finding relates to health care needs of women in general, especially elective procedures like cataract surgery, where a woman's psyche comes into play," says Hawker, also a member of the Canadian Arthritis Network and senior scientist with the Arthritis Community Research and Evaluation Unit (ACREU).
Hawker believes much of the problem lies in the interaction between a woman and her primary care physician. On the one hand physicians may be referring women less often or later than men, she says, but it may also be that women aren't properly articulating their concerns to their doctors. "Forty per cent of women with advanced arthritis live alone as compared to 10 per cent of men, raising concerns that women may have other domestic issues after surgery such as who will pay their bills and take care of them."
The population-based study surveyed all 48,218 person 55 years or older in two areas of Ontario to identify those with hip or knee problems, the severity of the illness and their willingness to undergo surgery. The study found an overall underuse of arthroplasty for both sexes, but the degree of underuse was three times as great in women.
"In the big picture, it costs the system much more to have an elderly person severely disabled by arthritis than if she were living independently in the community with a good knee," Hawker says. "This is a good procedure and we want to get these people what they need. We've got to understand why they're not getting it."
Arthritis is the most frequent cause of long-term physical disability in Canada, affecting one in 40 Canadians. A recently published study by ACREU projects that the number of Canadians with arthritis and related disabilities will more than double by 2031, with half of this increase occurring among Canadians aged 45 to 64. According to the Canadian Arthritis Network, more than 50 per cent of Canadians of working age with arthritis-related disabilities are forced to leave the labour force because of their condition. The ratio for women compared to men with osteoarthritis is two to one; for rheumatoid arthritis the ratio is five to two.
This study was funded by the Medical Research Council of Canada, the Arthritis Society of Canada, Physicians' Services Foundation, the Canadian Orthopedic Foundation and the University of Toronto Dean's Fund.