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Body matters
Do men get more knee surgery than women?
A new report suggests that Canadian doctors may unwittingly favour men when it comes to recommendations for knee replacement surgery, but UK doctors doubt whether it happens in the UK
When two patients with an arthritic knee – one male and one female – were sent to 71 doctors in Ontario in Canada, twice as many recommended knee replacement surgery to the man as to the woman. That was despite the fact that both were classified as having moderate knee arthritis and their knees were in near-identical condition.
The two patients were instructed on how to report their symptoms to each doctor to ensure their descriptions of discomfort, morning stiffness and pain were the same. Both told doctors that alternative treatments had not helped alleviate the pain.
Despite the similarity of their cases, 67 percent of the doctors recommended knee replacement surgery to the male patient, compared to just 33 percent recommending it to the female. Nearly half only recommended surgery to the man but not the woman yet only 8 percent did the reverse, suggesting surgery only for the woman and not the man. Having a female doctor didn’t make a difference.
The doctors – roughly half GPs and half orthopaedic surgeons – knew they would be seeing some patients included in a study but they weren’t told which patients they were or the purpose of the study.
The researchers, whose findings are published in the Canadian Medical Association Journal give a number of reasons for the gender bias, including overt discrimination by the physician. However, senior researcher, Dr James Wright of the University of Toronto and the Hospital for Sick Children said doctors’ preconceptions about different patient types were probably more likely to blame. Stereotyping could unconsciously affect a doctor’s decision without them being aware of it, rather than any deliberate act of discrimination against female patients, the report said.
Surgeons in the UK were surprised by the research, ‘A recommendation for knee replacement surgery is based on a patient’s pain levels, disability and age – gender just doesn’t come into it,’ says Dr Lawrence Freedman, consultant orthopaedic surgeon at Wellington Hospital in London. ‘Male knee surgery is often from playing football or other sports 30-odd years ago – a time when men probably were more active than women. But that’s changing now.’
Dr Nick Fiddian, President of the Knee Society, agrees: ‘In fact, if you look at the National Joint Registry, more women than men are now having knee replacements as they live longer. To be put forward for surgery, a patient must have evidence of osteoarthritis in their knee X-ray, experiencing pain whilst walking that’s restricting their exercise and conservative treatments for osteoarthritis will have proved unsuccessful. Those criteria are exactly the same, whether you’re male or female.’
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