The effect of patients' sex on physicians' recommendations for total knee arthroplasty
Open accessAbstract
BACKGROUND: The underuse of total joint arthroplasty in appropriate candidates is more than 3 times greater among women than among men. When surveyed, physicians report that the patient's sex has no effect on their decision-making; however, what occurs in clinical practice may be different. The purpose of our study was to determine whether patients' sex affects physicians' decisions to refer a patient for, or to perform, total knee arthroplasty. METHODS: Seventy-one physicians (38 family physicians and 33 orthopedic surgeons) in Ontario performed blinded assessments of 2 standardized patients (1 man and 1 woman) with moderate knee osteoarthritis who differed only by sex. The standardized patients recorded the physicians' final recommendations about total knee arthroplasty. Four surgeons did not consent to the inclusion of their data. After detecting an overall main effect, we tested for an interaction with physician type (family physician v. orthopedic surgeon). We used a binary logistic regression analysis with a generalized estimating equation approach to assess the effect of patients' sex on physicians' recommendations for total knee arthroplasty. RESULTS: In total, 42% of physicians recommended total knee arthroplasty to the male but not the female standardized patient, and 8% of physicians recommended total knee arthroplasty to the female but not the male standardized patient (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.4-7.3, p < 0.001; risk ratio [RR] 2.1, 95% CI 1.5-2.8, p < 0.001). The odds of an orthopedic surgeon recommending total knee arthroplasty to a male patient was 22 times (95% CI 6.4-76.0, p < 0.001) that for a female patient. The odds of a family physician recommending total knee arthroplasty to a male patient was 2 times (95% CI 1.04-4.71, p = 0.04) that for a female patient. INTERPRETATION: Physicians were more likely to recommend total knee arthroplasty to a male patient than to a female patient, suggesting that gender bias may contribute to the sex-based disparity in the rates of use of total knee arthroplasty.
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Gendered assumptions are pervasive in medical interventions and treatment.
“Examples in the literature show the pervasiveness of gendered assumptions in medical interventions and treatment, and the negative effects they can have on women's health.85 86”
From Anterior cruciate ligament injury: towards a gendered environmental approach (2021) · cites this paper as [85]
Gendered assumptions in medical interventions and treatment can have negative effects on women's health.
“Examples in the literature show the pervasiveness of gendered assumptions in medical interventions and treatment, and the negative effects they can have on women's health.85 86”
From Anterior cruciate ligament injury: towards a gendered environmental approach (2021) · cites this paper as [85]
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- Authors
- Borkhoff, C. M., Hawker, G. A., Kreder, H. J., Glazier, R. H., Mahomed, N. N., & Wright, J. G.
- Affiliations
- Hospital for Sick Children (CA)
- St. Michael's Hospital (CA)
- Venue
- Canadian Medical Association Journal
- Publisher
- CMA Joule Inc.
- Published
- 2008-03-11
- Volume
- 178
- Issue
- 6
- Pages
- 681-687
- ISSN
- 0820-3946 (ISSN-L)
- 1488-2329
- PMC
- PMC2263116
- OpenAlex
- W2124463820
- Semantic Scholar
- ab91216bb63b28f4aa6f726f35075f76c4f994e4
- Cited by
- 254
- References
- 36
- Citations by year
- 2026: 6 · 2025: 15 · 2024: 20 · 2023: 14 · 2022: 6 · 2021: 13 · 2020: 33 · 2019: 20 · 2018: 6 · 2017: 13 · 2016: 13 · 2015: 7 · 2014: 13 · 2013: 17 · 2012: 11
- FWCI
- 16.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Canadian Medical Association Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Total Knee Arthroplasty Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
- Social Sciences › Gender Studies › Diversity and Career in Medicine
- Keywords
- total knee arthroplasty, sex differences, gender bias, knee osteoarthritis, general practitioners, orthopaedic surgeons, standardized patients
- MeSH terms
- Attitude of Health Personnel, Decision Making, Female, Humans, Male, Ontario, Orthopedics, Practice Patterns, Physicians', Physicians, Family, Probability, Surveys and Questionnaires, Referral and Consultation, Sex Factors, Confidence Intervals, Logistic Models, Odds Ratio, Patient Selection, Health Care Surveys, Arthroplasty, Replacement, Knee, Osteoarthritis, Knee
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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