Differences between men and women in the rate of use of hip and knee arthroplasty

Background: Previous studies suggest that, for some conditions, women recei ve fewer health care interventions than men. We estimated the potential nee d for arthroplasty and the willingness to undergo the procedure in both men and women and examined whether there were differences between the sexes. Methods: All 48,218 persons 55 years of age or older in two areas of Ontari o, Canada, were surveyed by mail and telephone to identify those with hip o r knee problems. In these subjects, we assessed the severity of arthritis a nd the presence of coexisting conditions by questionnaire, documented arthr itis by examination and radiography, and conducted interviews to evaluate t he subjects' willingness to undergo arthroplasty. The potential need for ar throplasty was defined by the presence of severe symptoms and disability, t he absence of any absolute contraindications to surgery, and clinical and r adiographic evidence of arthritis. The estimates of need were then adjusted for the subjects' willingness to undergo arthroplasty. Results: The overall response rates were at least 72 percent for the questi onnaires and interviews. As compared with men, women had a higher prevalenc e of arthritis of the hip or knee (age-adjusted odds ratio, 1.76; P<0.001) and had worse symptoms and greater disability, but women were less likely t o have undergone arthroplasty (adjusted odds ratio, 0.78; P<0.001). Despite their equal willingness to have the surgery, fewer women than men had disc ussed the possibility of arthroplasty with a physician (adjusted odds ratio , 0.63). The numbers of people with a potential need for hip or knee arthro plasty were 44.9 per 1000 among women and 20.8 per 1000 among men. After ad justment for willingness to undergo the procedure, the numbers were 5.3 per 1000 for women and 1.6 per 1000 for men. Conclusions: There is underuse of arthroplasty for severe arthritis in both sexes, but the degree of underuse is more than three times as great in wom en as in men. (N Engl J Med 2000;342:1016-22.) (C) 2000, Massachusetts Medi cal Society.