From the Department of Orthopedic Surgery, University of California at San Francisco, San Francisco, CA (Dr. Woolley, Dr. Allahabadi, Dr. Ward, and Dr. Wong) and University of California, San Francisco, San Francisco, CA (Ms. Chi, Ms. Fluet, Mr. Roach).
J Am Acad Orthop Surg Glob Res Rev. 2023 Aug 7;7(8). doi: 10.5435/JAAOSGlobal-D-23-00022. eCollection 2023 Aug 1.
Studies show that females have a higher prevalence of osteoarthritis, worse symptoms, but lower rates of joint replacement surgery (JRS). The reason for this remains unknown.
A database of JRS candidates was created for patients seen in 2019 at an academic center. Demographics, Kellgren-Lawrence grades, symptom duration, visual analogue pain score, Charlson Comorbidity Index, and nonsurgical treatments were collected. Patients who were offered but declined surgery were invited to focus groups. Two independent sample t-tests, Mann-Whitney U tests, and chi-square tests were used for continuous, scored, and categorical variables, respectively, with two-tailed significance <0.05. Qualitative, code-based analysis was performed for the focus groups.
The cohort included 321 patients (81 shoulder, 59 hip, and 181 knee) including 199 females (62.0%). There were no differences in proportions of females versus males who underwent JRS or in nonsurgical treatments. Female shoulder arthritis patients were older, had a higher visual analogue pain score, and had a higher Charlson Comorbidity Index. In focus groups, males prioritized waiting for technology advancements to return to an active lifestyle, whereas females experienced negative provider interactions, self-advocated for treatment, concerned about pain, and believed that their sex affected their treatment.
We found equal utilization of JRS at our institution. However, female patients experienced unique barriers to surgery.
研究表明，女性患骨关节炎的患病率更高，症状更严重，但接受关节置换手术（JRS）的比率较低。其原因尚不清楚。
为 2019 年在学术中心就诊的 JRS 候选患者创建了数据库。收集了人口统计学、Kellgren-Lawrence 分级、症状持续时间、视觉模拟疼痛评分、Charlson 合并症指数和非手术治疗情况。邀请那些被建议但拒绝手术的患者参加焦点小组。使用双侧显着性<0.05 的独立样本 t 检验、Mann-Whitney U 检验和卡方检验分别对连续、评分和分类变量进行分析。对焦点小组进行了基于代码的定性分析。
该队列包括 321 名患者（81 名肩部、59 名髋部和 181 名膝部），其中 199 名女性（62.0%）。接受 JRS 或非手术治疗的女性与男性的比例没有差异。女性肩部关节炎患者年龄更大，视觉模拟疼痛评分更高，Charlson 合并症指数更高。在焦点小组中，男性更倾向于等待技术进步以恢复积极的生活方式，而女性则经历了负面的提供者互动，主动寻求治疗，担心疼痛，并认为她们的性别影响了她们的治疗。
我们发现我们机构的 JRS 使用情况均等。然而，女性患者在手术方面面临独特的障碍。
