Why? “The researchers concluded that doctors had an unconscious bias,” says Dr. O’Connor, who is interested in reasons why women delay joint replacement but was not involved in the Canadian study. “They believed that the woman’s complaints were not bad enough to warrant a recommendation for surgery, even though the complaints and x-rays were similar.

Even when women with OA are offered the option of joint replacement surgery, research shows they are less likely to take advantage of it than men are. “When you look at women’s thoughts of surgery there is some evidence that they have a different perception about the benefits of surgery or their outcomes or their thoughts about anesthesia and pain and how recovery is going to affect their lives,” says Sharon Hame, MD, an orthopaedic surgeon at UCLA. “They may avoid it surgery because it would disrupt their caregiving responsibilities.”

Whatever the reasons for their hesitation, Dr. Hame says delays in surgery are responsible for more debilitating disease and less successful outcomes once they do pursue surgery. “As women wait longer, they come in with more debilitating disease and surgery is more difficult because of that. Outcomes in women may not be as good because they have started out worse.”

The good news is that women who have knee replacement surgery can expect to have as much improvement as men; therefore, if women were to discuss surgery earlier in the disease process they would likely have similar outcomes to men, she says.

Specialized Treatment

“More women should be educated about joint replacement, and doctors should be made aware of the need to discuss this treatment option with their female patients,” says Dr. Hame. “However efforts should – and are –being made to tailor gender-specific treatments.”

Companies have developed gender-specific braces that fit the contours of a women’s leg and gender-specific knee prostheses that are designed for women’s smaller joint structure, says Dr. Hame.  “We don’t have evidence yet that that [these prostheses] are more beneficial for women, but it makes sense that you would have smaller components because some have smaller knees and patellas.” Similarly, there isn’t scientific evidence to support the use of gender-specific braces, but the concept makes sense, she says. Research into these customized devices is ongoing and she believes they will likely hold a place in osteoarthritis treatment as scientists better understand differences in joint mechanics and the degenerative process.

Dr. Hame says further research is needed to study the effectiveness of both new and existing OA treatments on women specifically. Much of the current treatment for OA, like most other diseases, is based on research done in men, she says. Increasingly, that is changing. Certain journals now require some type of gender analysis on studies of treatments that are likely to be used in both men and women. “In things like surgical procedures and medications that are used in men and women, females need to be included in the study and then compared to men --I think that will help dramatically improve awareness,” she says. “If we specifically analyze women and compare men and women, we may find that there are specific drugs or treatments or injectibles that are more helpful for women than men.” That knowledge, she says, could eventually lead to treatment specific to gender.”

“I personally think that we will develop sex-based therapy!” says Dr. O’Connor. “We don’t have that presently but I believe that is our future direction.”

In the meantime, she says it is up to women to speak up, particularly if they feel their doctor is not taking their symptoms seriously or fails to offer them the treatment options they would offer men.  “I firmly believe that if a woman does not think her doctor is ‘hearing her voice’ that she should directly ask her doctor whether her symptoms are being taken seriously,” Dr. O’Connor says. “First try to work with your care provider, but seek another if you don’t believe your voice is being heard. Our health is too important!”