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Gender-Based Differences in Arthroplasty Utilization Across Two Tertiary Academic Centers
Mikayla R Mefford1, Charlotte F Wahle, Emma D Grellinger
1From the David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA (Ms. Mefford and Ms. Wahle); the School of Medicine, University of California San Francisco, San Francisco, CA (Ms. Grellinger and Ms. Chi); the Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA (Dr. Newman-Hung, Dr. Stavrakis, and Dr. Wessel); the Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA (Dr. Woolley, Dr. Dlott, and Dr. Wong); and the Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA (Dr. Jackson).
Background:
Women have a higher prevalence of osteoarthritis and report worse symptoms, yet they undergo joint replacement surgery (JRS) at lower rates than men. Studies suggest that cultural norms, healthcare access, physician biases, and patient preferences may contribute to disparities, but consensus on gender-specific barriers in JRS utilization remain unclear.
Methods:
From a database of JRS candidates seen in 2022 at two tertiary academic centers, patients who were offered but declined surgery were invited to participate in focus groups (FGs). Demographics, Kellgren-Lawrence grades, symptom duration, visual analog pain score, Charlson Comorbidity Index, and nonsurgical treatments were collected. Statistical analysis included chi-square, analysis of variance, and t-tests. FGs explored patient treatment experiences using code-based qualitative analysis.
Results:
The database cohort included 976 patients (140 shoulder, 493 hip, and 343 knee), with 60% female. No notable sex differences were found in JRS utilization. FG participants (n = 24) included 12 women and 12 men. Women were younger than men (70.9 ± 9.6 vs. 73.4 ± 6.1). Both men and women reported negative physician interactions and identified return to lifestyle as key in influencing surgery decisions. Men expressed concerns about hobbies, recovery support, and felt encouraged to undergo surgical treatment. Women prioritized household responsibilities, cosmetic outcomes, and trialed alternative treatments more often and endorsed age- and gender-based biases in care.
Conclusion:
Gender-based differences influence patient experiences and decision making regarding JRS. Although men felt supported in pursuing surgery, women perceived bias and exhausted conservative treatments first. These findings highlight the need for shared decision-making frameworks that address gender-based disparities in surgical care.
