Disparities: Men Likelier to Be Told to Replace a Knee

By NICHOLAS BAKALAR


Women are less likely than men to get a recommendation for knee replacement, a Canadian study reports, even when they have the same symptoms.

The researchers selected one man and one woman, both 67, who had identical levels of knee osteoarthritis, as confirmed by two physicians who examined the patients and their X-rays. Then the pair visited 29 orthopedic surgeons and 38 family physicians, with instructions to present their symptoms in exactly the same way: a standard opening sentence describing their problem and ending with the question, “Do you think I need a new knee?”

The researchers found that two-thirds of the doctors recommended knee replacement for the man, while only a third thought it appropriate for the woman. The study, led by Dr. James G. Wright, a professor of surgery at the University of Toronto, appears in the March 11 issue of The Canadian Medical Association Journal. (Knee replacements are covered under the Canadian national health plan.)

Only 12 of the doctors were women, not enough to determine whetehr male and female doctors would perform differently. Of the female physicians, five recommended surgery only to the man; two only to the woman; three to both; and two to neither.

“Women are less likely to get this very effective surgical procedure,” Dr. Wright said. “They should be more aggressive in challenging doctors, especially by getting second opinions.”