Special Article
Differences between Men and Women in the Rate of Use of Hip and Knee Arthroplasty
N Engl J Med 2000; 342:1016-1022April 6, 2000
- Abstract
Background
Previous studies suggest that, for some conditions, women receive fewer health care interventions than men. We estimated the potential need for arthroplasty and the willingness to undergo the procedure in both men and women and examined whether there were differences between the sexes.
Methods
All 48,218 persons 55 years of age or older in two areas of Ontario, Canada, were surveyed by mail and telephone to identify those with hip or knee problems. In these subjects, we assessed the severity of arthritis and the presence of coexisting conditions by questionnaire, documented arthritis by examination and radiography, and conducted interviews to evaluate the subjects' willingness to undergo arthroplasty. The potential need for arthroplasty was defined by the presence of severe symptoms and disability, the absence of any absolute contraindications to surgery, and clinical and radiographic evidence of arthritis. The estimates of need were then adjusted for the subjects' willingness to undergo arthroplasty.
Results
The overall response rates were at least 72 percent for the questionnaires and interviews. As compared with men, women had a higher prevalence of arthritis of the hip or knee (age-adjusted odds ratio, 1.76; P<0.001) and had worse symptoms and greater disability, but women were less likely to have undergone arthroplasty (adjusted odds ratio, 0.78; P<0.001). Despite their equal willingness to have the surgery, fewer women than men had discussed the possibility of arthroplasty with a physician (adjusted odds ratio, 0.63). The numbers of people with a potential need for hip or knee arthroplasty were 44.9 per 1000 among women and 20.8 per 1000 among men. After adjustment for willingness to undergo the procedure, the numbers were 5.3 per 1000 for women and 1.6 per 1000 for men.
Conclusions
There is underuse of arthroplasty for severe arthritis in both sexes, but the degree of underuse is more than three times as great in women as in men.
Media in This Article
Table 1
Overview of Study Participants.Table 2
Comparison of Male and Female Phase 2 Respondents.Article Activity
- Article
Studies have aroused concern that some types of surgical procedures, such as coronary revascularization and renal transplantation, are performed less often in women than they should be.1-6 However, the interpretation of these findings is difficult because of possible differences between men and women in the prevalence of disease, contraindications to surgery, and preferences with respect to surgery. Whether there are differences between men and women in the rate of use of arthroplasty has not been previously addressed.
Osteoarthritis is the leading cause of long-term disability.7-9 The prevalence of osteoarthritis-related disability is greater among women than among men.10 Thus, arthritis is a major health problem for women. Joint arthroplasty is an efficacious and cost-effective treatment for advanced arthritis of the hip and knee that relieves pain and reduces functional disability.11-14 The age-adjusted rates of hip and knee arthroplasty are higher for women than for men in both the United States and Canada.15-17 However, because these rates have not been adjusted for the higher incidence of arthritis10 and osteoporosis-related hip fracture17 among women than among men, they do not indicate whether there is a difference between men and women in the proportion of people in need of arthroplasty who actually undergo the procedure.
Previous studies have reported that women have worse pain and disability than men at the time of arthroplasty.11,18 These studies suggest that women receive treatment later in the course of their disease. We undertook this study to determine whether there are differences between men and women in the potential need for arthroplasty and in the willingness to undergo the procedure.
Methods
Study Sample
The study was conducted in three phases. The names and addresses of persons 55 years of age or older were obtained from residential tax records provided by the Ontario Ministry of Finance. Younger people were not included because they have a low prevalence of advanced hip and knee arthritis9,10,19,20 and seldom undergo arthroplasty.15 Because residents of Ontario have comprehensive, universal health insurance coverage, barriers to health care based on insurance status were not an issue. In phase 1 of our study, a brief questionnaire was sent to the listed residents of two areas of the province, Oxford County and East York. Oxford County is a rural area with an ethnically homogeneous population and a high rate of arthroplasty. East York is an area in metropolitan Toronto with an ethnically diverse population and a low rate of arthroplasty. A total of 21,925 questionnaires were sent out in Oxford County and 26,293 in East York. Eligible residents who did not respond after two additional mailings were telephoned in accordance with the modified methods of the U.S. National Center for Health Statistics.21 To estimate the proportions of the sample that were ineligible or did not respond, extensive tracing methods22 were used for random samples of 500 nonrespondents from each of the two areas with the use of telephone and city directories from 1991 through 1998.
Collection of Data
In the phase 1 questionnaire, participants identified joints with symptoms of arthritis on a diagram, reported whether they had specific functional disabilities, and stated whether they had undergone arthroplasty. Respondents were selected for phase 2 of the study if they had at least moderately severe hip or knee arthritis, as defined by the presence of all of the following: difficulty with climbing stairs, arising from a chair, standing, and walking during the previous three months; swelling, pain, or stiffness in any joint lasting at least six weeks during the previous three months; and a symptomatic hip or knee identified on the diagram on the phase 1 questionnaire.
In phase 2, the respondents completed three questionnaires that have been demonstrated to be reliable and valid measures of the severity of hip and knee problems: the Western Ontario McMaster University Osteoarthritis Index (WOMAC),23 the 36-item Short-Form Health Survey,24,25 and the disability subscale of the Health Assessment Questionnaire.26 They were also given a list of 18 health problems and asked which ones they had been treated for or had seen a physician about in the past year.
Although there are no universally accepted criteria for the appropriateness of arthroplasty, the National Institutes of Health (NIH) consensus statement suggests that candidates for arthroplasty should have “radiographic evidence of joint damage and moderate to severe persistent pain or disability, or both.”27 For the purposes of this study, “severe” arthritis was arbitrarily defined by a WOMAC summary score of 39 or greater. The WOMAC summary score ranges from 0 (no pain or disability) to 100 (the most severe pain and disability); the cutoff score of 39 represents the 25th percentile of scores for patients undergoing arthroplasty in Ontario.28 This cutoff was chosen to provide a conservative estimate of the potential need for arthroplasty. People with scores of 39 or higher were considered potential candidates for arthroplasty if they reported no absolute contraindications to arthroplasty and had both clinical and radiographic evidence of arthritis. According to more than 90 percent of orthopedic surgeons in Ontario, the absolute contraindications to arthroplasty are major mental illness, stroke with paralysis, or another major neurologic disorder.29
In phase 3, to determine the sensitivity and specificity of our WOMAC summary-score cutoff in identifying persons with arthritis, we visited and examined all respondents in East York who had scores of at least 39 (indicating severe arthritis) and a random sample of persons with scores of 7 to 38 (indicating mild-to-moderate arthritis). The participants underwent a standardized joint examination,30 which included the assessment of range of motion, tenderness, pain on movement of the joint (stress pain), swelling, and deformity. Anteroposterior radiographs of the pelvis and anteroposterior and lateral radiographs of the knees with the participant standing were obtained by a standardized procedure. Each radiograph was reviewed blindly by one of two radiologists and graded for the presence of osteophytes, subchondral sclerosis, marginal erosions, subchondral cysts, and narrowing of the joint space. A hip or knee was classified as arthritic if there was stress pain, reduced range of motion, or deformity on examination and if the radiologist observed osteophytes, subchondral sclerosis, marginal erosions, subchondral cysts, or narrowing of the joint space.
In both study areas, respondents with severe hip or knee arthritis who had not undergone arthroplasty and were not on a waiting list for arthroplasty were interviewed to determine their willingness to undergo arthroplasty. We did not interview persons who had previously undergone joint arthroplasty or who were currently on a waiting list for arthroplasty, since these persons were deemed to have a need for arthroplasty that had been met. Furthermore, persons on a waiting list for arthroplasty were assumed to be “definitely willing” to undergo arthroplasty. Since orthopedic surgeons have varied opinions regarding the risks and benefits of arthroplasty,29 a standardized interview was essential to provide identical information to the respondents. The interview, based on audiotapes of 10 patient–surgeon discussions, was designed to simulate a typical conversation between a patient and a surgeon. The interview described the consequences of not having surgery, alternative treatments, and the risks and benefits of arthroplasty, including the projected life span of the replaced joint.29,31 The risks of arthroplasty were discussed in greater detail than is usually done by orthopedic surgeons, biasing the study toward providing a conservative estimate of patients' willingness to undergo surgery. Participants indicated their degree of willingness to have arthroplasty on a five-point scale: “definitely not willing,” “probably not willing,” “unsure,” “probably willing,” and “definitely willing.” Joint examinations and interviews were performed by trained therapists from the Arthritis Society of Canada.
In this study, persons with a potential need for arthroplasty were defined as those with severe arthritis (a WOMAC score of at least 39), no absolute contraindications to surgery, and both clinical and radiologic evidence of arthritis. The estimates of potential need were then adjusted for willingness. Only those persons who indicated “definite” willingness to have arthroplasty were considered to be willing to undergo the procedure.
Statistical Analysis
The demographic and socioeconomic characteristics of respondents to the phase 1 questionnaire were compared with 1991 census data for East York, Oxford County, and Canada overall. The potential need for and willingness to undergo arthroplasty were expressed per 1000 respondents in phase 1. Stepwise multivariate logistic-regression modeling was used to evaluate the independent determinants of having previously undergone arthroplasty (according to data from phase 1), requiring personal assistance with daily activities, being on a waiting list for arthroplasty (according to data from phase 2), and having ever spoken with a physician about arthroplasty (according to data from phase 3). The goodness of fit of the models was assessed by the Hosmer–Lemeshow test statistic.32 All analyses were first performed on the data from the two areas separately and were then performed on the combined data set. For all analyses, a two-tailed P value of 0.05 or less was considered to indicate statistical significance.
The human subjects review committee of the University of Toronto approved all phases of the study, and the subjects gave oral informed consent to participate in the study in phases 1 and 2 and written informed consent to participate in phase 3.
Results
The results of the analyses according to sex were similar in the two areas, and therefore all reported results are for the combined data set. The numbers of people eligible for the study and their response rates are summarized in Table 1Table 1
Overview of Study Participants.. The overall response rates for all questionnaires and interviews were 72 percent or higher. Higher response rates were associated with higher income and lower frequency of moving to a new residence in the prior year, but not with sex or age. Sociodemographically, phase 1 respondents were highly representative of the Canadian population as a whole.33 Fifty-eight percent of phase 1 respondents were female. Women were older than men (mean age, 69.4 vs. 67.7 years; P<0.001) and were more likely to report that a physician had given them a diagnosis of arthritis (52.6 percent vs. 38.0 percent; age-adjusted odds ratio, 1.76; P<0.001). After adjustment for age and the prevalence of self-reported arthritis, women were more likely than men to report chronic hip or knee problems (adjusted odds ratio, 1.16; 95 percent confidence interval, 1.11 to 1.21) and to have seen their family physician in the past year for this reason (adjusted odds ratio, 1.15; 95 percent confidence interval, 1.04 to 1.24).
Among the phase 1 respondents, 5.1 percent had undergone joint arthroplasty. After adjustment for age and the self-reported presence of osteoporosis and arthritis, women were less likely than men to have undergone arthroplasty of either the hip or the knee (adjusted odds ratio, 0.78; 95 percent confidence interval, 0.72 to 0.90), of the hip alone (adjusted odds ratio, 0.62; 95 percent confidence interval, 0.34 to 0.84), and of the knee alone (adjusted odds ratio, 0.54; 95 percent confidence interval, 0.21 to 0.80).
Among the phase 1 respondents, 14.3 percent of women and 8.0 percent of men (P<0.001) had at least moderately severe hip or knee problems and thus met the criteria for phase 2. As compared with men, women in phase 2 were older (P<0.001), were more likely to live alone (P=0.001), had worse (higher) WOMAC scores (P<0.001), had worse (lower) scores on physical functioning (P<0.001) and vitality (P< 0.001) subscales of the Short-Form Health Survey, and were more likely to require regular personal assistance in performing daily activities because of their arthritis (P=0.001) (Table 2Table 2
Comparison of Male and Female Phase 2 Respondents.).Among the phase 2 respondents, 5.5 percent of the women and 5.8 percent of the men were on a waiting list for arthroplasty (P=0.73). After adjustment for age, general health, and measures of the severity of arthritis, women were less likely than men to be on a waiting list for arthroplasty (adjusted odds ratio, 0.71; 95 percent confidence interval, 0.44 to 1.15). However, this difference did not reach statistical significance. Among those on a waiting list for arthroplasty, men and women did not differ in age or in disease severity according to WOMAC scores.
Of the 1325 phase 2 respondents with severe arthritis (a WOMAC score of at least 39), 74.9 percent were women. After the exclusion of 220 respondents with self-reported absolute contraindications to arthroplasty and adjustment for the 115 respondents (10.4 percent) with WOMAC scores of at least 39 who did not have both clinical and radiographic evidence of arthritis in at least one hip or knee, there were 990 persons with a potential need for arthroplasty. Among these, there were no significant differences between men and women in the severity of arthritis according to clinical examination or radiographic assessment or in the incidence of coexisting conditions (Table 2). The numbers of phase 1 responders with a potential need for arthroplasty were 44.9 per 1000 for women and 20.8 per 1000 for men (Table 3Table 3
Estimated Numbers of Phase 1 Respondents with Potential Need for Arthroplasty.).Among those with a potential need for arthroplasty, 32.5 percent of women and 41.8 percent of men reported having ever discussed arthroplasty with a physician (Table 2). Of these, 19.0 percent and 25.6 percent, respectively, had ever discussed arthroplasty with an orthopedic surgeon. After adjustment for age and disease severity, women were less likely ever to have discussed arthroplasty with any physician (adjusted odds ratio, 0.63; P=0.01) (Table 4Table 4
Odds Ratios for Ever Having Discussed Arthroplasty with a Physician among Subjects with a Potential Need for Arthroplasty.), and specifically with an orthopedic surgeon (adjusted odds ratio, 0.65; P=0.04). However, among those who had discussed arthroplasty with an orthopedic surgeon, women and men were equally likely to have had surgery recommended (42 percent for both sexes). Among those for whom arthroplasty had been recommended, no differences in age or WOMAC scores were found between the sexes. The cited reasons for having not yet had arthroplasty when it had been recommended were similar for women and men, except that women were less risk averse (P<0.001) and were more likely to be still waiting to see the orthopedic surgeon (P=0.18) (Table 5Table 5
Reasons Patients Who Had Discussed Arthroplasty with a Physician Did Not Undergo the Procedure.). Among those for whom arthroplasty had not been recommended, the reasons reported were similar for both sexes (Table 5).Among persons with a potential need for arthroplasty, 12.7 percent of women and 8.8 percent of men were “definitely willing” to have arthroplasty; the adjusted estimates of need per 1000 phase 1 respondents were 5.3 in women and 1.6 in men (Table 3).
Discussion
In this population-based study, we found that arthroplasty was underused in both men and women, and that the degree of underuse was significantly greater for women. The estimated potential need for arthroplasty was more than twice as great among women as among men because of the higher prevalence of severe hip and knee arthritis in women. Women and men were equally likely to be excluded as candidates for arthroplasty. In comparison with men, women had greater arthritis pain, were more likely to be disabled, and were more likely to require personal assistance in performing daily activities, largely because they were more likely to live alone. These findings suggest that underuse of arthroplasty may have substantial direct costs to the health care system and indirect costs to society, and that more of these costs are due to underuse in women than in men. The observed disparity between men and women in the rate of arthroplasty may be even greater in countries other than Canada, such as the United States, where insurance status may pose a further barrier to access to health care, and where the barriers are greater for women than for men because of socioeconomic factors.
A prior study suggested that women and men differ in their preferences with respect to arthroplasty. Karlson et al.34 conducted focus-group discussions among patients with moderately severe osteoarthritis of the hip or knee who had either undergone arthroplasty or were on a waiting list for arthroplasty. As compared with men, women declined to a lower functional level before considering arthroplasty, were more averse to surgical risk and more concerned about being a burden on the family, and wanted more information before making a decision. The primary limitation of the study was that it evaluated only patients who had undergone or were about to undergo arthroplasty. In our study, which recruited subjects from the community independently of their interaction with the health care system, we found no difference between men and women in their willingness to undergo arthroplasty, after adjustment for the severity of disease and for coexisting conditions. Furthermore, the reported reasons for refusing arthroplasty when it had been offered were similar for men and women, except that men were more likely to refuse arthroplasty because they considered it “too risky.”
Although women were more likely than men to seek treatment for arthritis and had similar levels of self-reported coexisting conditions, women with a potential need for arthroplasty were less likely than men to report having ever discussed arthroplasty with a physician. These findings are provocative and suggest that a possible explanation for the observed sex differences in the potential need for arthroplasty may be that women are less likely to be referred, or perhaps are referred after a longer interval, to orthopedic surgeons for consideration for arthroplasty. Such a delay might occur because women are less likely to initiate discussions about their arthritis or its treatment, or are less demanding of surgery when it is discussed. These differences could be due to differences in personality between the sexes, but they could also reflect interactions at the level of family, friends, and colleagues. Alternatively, primary care providers may have attitudes regarding the risks of, indications for, and expected outcomes of arthroplasty that make them consider women less appropriate candidates for surgery than men. Studies of differences in the provision of coronary arteriography and cardiac bypass surgery to women and men have suggested there may be sexually based biases in the choice of patients for these procedures.35 Although we have previously shown that Ontario family physicians overestimate the risks and underestimate the benefits of arthroplasty,36 these same physicians reported in a survey that the sex of the patient did not affect their decision whether to refer the patient to an orthopedic surgeon for arthroplasty. Further research is warranted.
There are several potential limitations to our study. First, in an effort to factor into our estimates of potential need for arthroplasty the important influence of patients' preferences, we adjusted our estimates of potential need by the patient's degree of willingness to have arthroplasty. The latter was evaluated by means of a standardized interview rather than through conversations with an orthopedic surgeon. We used this approach to provide a standard and comprehensive list of the potential risks and benefits associated with arthroplasty in the light of our prior research, which documented substantial variation among orthopedic surgeons in their opinions regarding the indications for and outcomes of arthroplasty.29 We believe that because we listed all possible risks associated with arthroplasty, we obtained conservative estimates of willingness to undergo arthroplasty. Furthermore, our approach is unlikely to have had different effects on the estimates of willingness in men and in women.
Second, since there are no standardized guidelines regarding when and in whom arthroplasty should be performed, our criteria for potential need were based on self-reported symptoms and disability and obtained with use of a reliable and valid instrument (the WOMAC) that is widely used in North America to evaluate the outcomes of arthroplasty. Since studies indicate that the primary reasons reported by patients for undergoing arthroplasty are joint pain and functional limitation,11 these criteria seem reasonable. Furthermore, the estimates of need were adjusted both for the likelihood that persons with high scores had both radiographic and clinical evidence of arthritis and for contraindications to surgery.
Third, although there were no differences in the severity of arthritis between men and women who were on waiting lists for arthroplasty, we did not ask subjects how long they had been on the waiting list. Thus, we do not know whether there are differences between men and women in the waiting period once the decision has been made to go ahead with surgery. However, we previously found no association between the sex of the patient and the waiting time for knee arthroplasty,37 and we have no reason to believe, on the basis of our current findings, that prolonged waiting times for arthroplasty explain either the unmet need for arthroplasty or the differences between men and women in the rate of use of arthroplasty. Finally, we did not obtain information on employment status and therefore do not know whether sex differences in employment status account in part for our findings.
In conclusion, after adjustment for the degree of willingness to undergo arthroplasty, the potential need for arthroplasty was more than three times as great among women as among men. Furthermore, women were more likely than men to be disabled by arthritis, since they were more likely to live alone. Nevertheless, as compared with men, women were less likely to have undergone arthroplasty, and those with potential need were less likely to have discussed arthroplasty with a physician. On the basis of these findings, we propose that the most likely explanation is that barriers, perceived or actual, that are unique to women exist at the level of the interaction between the primary care provider and the patient in the process of referral to orthopedic surgery.
Supported by grants from the Medical Research Council of Canada (MT-12919), the Arthritis Society of Canada (97-083), Physicians' Services Foundation (95-47), the Canadian Orthopaedic Foundation, and the University of Toronto Dean's Fund (00026896).
We are indebted to Nishma Kanji for her work as study coordinator, Lyn Maguire for her management of the in-home assessments, and Annette Wilkins for both her assistance in data preparation and analysis and her continued commitment to this project.
Source Information
From the Department of Medicine, Division of Rheumatology, Faculty of Medicine, University of Toronto, and Women's College Hospital Campus, Sunnybrook and Women's College Health Sciences Centre (G.A.H.); the Clinical Epidemiology and Health Care Research Program (G.A.H., J.G.W., J.I.W., R.G., E.M.B.); the Department of Surgery, Division of Orthopaedic Surgery, Hospital for Sick Children (J.G.W.); the Department of Family and Community Medicine, University of Toronto (J.I.W.); the Department of Family and Community Medicine, St. Michael's Hospital (R.G.); the Departments of Health Administration (G.A.H., P.C.C.) and Public Health Sciences (J.G.W., J.I.W., B.H., R.G., E.M.B.), University of Toronto; the Arthritis Community Research and Evaluation Unit, Wellesley Hospital Research Institute (G.A.H., P.C.C., R.G., E.M.B.); and the Institute for Clinical Evaluative Sciences (P.C.C., J.I.W.) — all in Toronto.
Address reprint requests to Dr. Hawker at Women's College Hospital Campus, Sunnybrook and Women's College Health Sciences Centre, 76 Grenville St., 10th Fl., Toronto, ON M5S 1B2, Canada, or at g.hawker@utoronto.ca.
- References
References
1
Gijsbers van Wijk CMT ,van Vliet KP ,Kolk AM . Gender perspectives and quality of care: towards appropriate and adequate health care for women. Soc Sci Med 1996;43:707-720
CrossRef | Web of Science | Medline2
Weitzman S ,Cooper L ,Chambless L , et al. Gender, racial, and geographic differences in the performance of cardiac diagnostic and therapeutic procedures for hospitalized acute myocardial infarction in four states. Am J Cardiol 1997;79:722-726
CrossRef | Web of Science | Medline3
Bergelson BA ,Tommaso CL . Gender differences in percutaneous interventional therapy of coronary artery disease. Cathet Cardiovasc Diagn 1996;37:1-4
CrossRef | Medline4
Bell MR ,Berger PB ,Holmes DR Jr ,Mullany CJ ,Bailey KR ,Gersh BJ . Referral for coronary artery revascularization procedures after diagnostic coronary angiography: evidence for gender bias? J Am Coll Cardiol 1995;25:1650-1655
CrossRef | Web of Science | Medline5
Giacomini MK . Gender and ethnic differences in hospital-based procedure utilization in California. Arch Intern Med 1996;156:1217-1224
CrossRef | Web of Science | Medline6
Bloembergen WE ,Mauger EA ,Wolfe RA ,Port FK . Association of gender and access to cadaveric renal transplantation. Am J Kidney Dis 1997;30:733-738
CrossRef | Web of Science | Medline7
Kramer JS ,Yelin EH ,Epstein WV . Social and economic impacts of four musculoskeletal conditions: a study using national community-based data. Arthritis Rheum 1983;26:901-907
CrossRef | Web of Science | Medline8
Hadler NM . Osteoarthritis as a public health problem. Clin Rheum Dis 1985;11:175-185
Medline9
Badley EM ,Rasooly I ,Webster G . Relative importance of musculoskeletal disorders as a cause of chronic health problems, disability, and health care utilization: findings from the 1990 Ontario Health Survey. J Rheumatol 1994;21:505-514
Web of Science | Medline10
Peyron JG, Altman RD. The epidemiology of osteoarthritis. In: Moskowitz RW, Howell DS, Goldberg VM, Mankin HJ, eds. Osteoarthritis: diagnosis and medical/surgical management. 2nd ed. Philadelphia: W.B. Saunders, 1992:15-37.
11
Hawker GA ,Wright JG ,Coyte PC , et al. Health-related quality of life after knee replacement. J Bone Joint Surg Am 1998;80:163-173
Web of Science | Medline12
Chang RW ,Pellisier JM ,Hazen GB . A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip. JAMA 1996;275:858-865
CrossRef | Web of Science | Medline13
Bunker JP ,Frazier HS ,Mosteller F . Improving health: measuring effects of medical care. Milbank Q 1994;72:225-258
CrossRef | Web of Science | Medline14
Liang MH ,Cullen KE ,Larson MG , et al. Cost-effectiveness of total joint arthroplasty in osteoarthritis. Arthritis Rheum 1986;29:937-943
CrossRef | Web of Science | Medline15
Variation in surgical services over time and by site of residence. In: Naylor CD, Anderson GM, Goel V, eds. Patterns of health care in Ontario. Vol. 1 of ICES practice atlas. Ottawa, Ont.: Canadian Medical Association, 1994:69-136.
16
Katz BP ,Freund DA ,Heck DA , et al. Demographic variation in the rate of knee replacement: a multi-year analysis. Health Serv Res 1996;31:125-140
Web of Science | Medline17
DeBoer D, Williams JI. Surgical services for total hip and total knee replacements: trends in hospital volumes and length of stay for total hip and total knee replacement. In: Badley EM, Williams JI, eds. Patterns of health care in Ontario: arthritis and related conditions. ICES practice atlas. Toronto: Continental Press, 1998:121-4.
18
Katz JN ,Wright EA ,Guadagnoli E ,Liang MH ,Karlson EW ,Cleary PD . Differences between men and women undergoing major orthopedic surgery for degenerative arthritis. Arthritis Rheum 1994;37:687-694
CrossRef | Web of Science | Medline19
McAlindon TE ,Cooper C ,Kirwan JR ,Dieppe PA . Knee pain and disability in the community. Br J Rheumatol 1992;31:189-192
CrossRef | Medline20
Dodge HJ ,Mikkelsen WM ,Duff IF . Age-sex specific prevalence of radiographic abnormalities of the joints of the hands, wrists and cervical spine of adult residents of the Tecumseh, Michigan, Community Health Study area, 1962-1965. J Chronic Dis 1970;23:151-159
CrossRef | Medline21
Massey JT. Overview of the National Health Interview Survey and its sample design. Vital and health statistics. Series 2. No. 110. Washington, D.C.: Government Printing Office, 1989:1-5.
22
Harvey B, Miller AB, Baines CJ, Corey P. The effect of consulting publicly available sources to locate subjects in a study of recall bias. In: Proceedings of the 160th National Meeting of the American Association for the Advancement of Science, San Francisco, February 18–23, 1994. Washington, D.C.: American Association for the Advancement of Science, 1994:138. abstract.
23
Bellamy N ,Buchanan WW ,Goldsmith CH ,Campbell J ,Stitt LW . Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988;5:1833-184024
Stewart AL ,Hays RD ,Ware JE Jr . The MOS short-form general health survey: reliability and validity in a patient population. Med Care 1988;26:724-735
CrossRef | Web of Science | Medline25
Ware JE Jr, Snow KK, Kosinski M, Gandek B. SF-36 Health survey: manual and interpretation guide. Boston: Health Institute, New England Medical Center, 1993.
26
Ramey DR ,Raynauld J-P ,Fries JF . The Health Assessment Questionnaire 1992: status and review. Arthritis Care Res 1992;5:119-129
CrossRef | Medline27
NIH Consensus Development Conference on total hip replacement. Bethesda, Md.: National Institutes of Health, 1994:1-31.
28
Wright JG ,Young NL . The Patient-Specific Index: asking patients what they want. J Bone Joint Surg Am 1997;79:974-983
Web of Science | Medline29
Wright JG ,Coyte PC ,Hawker GA , et al. Variation in orthopedic surgeons' perceptions of the indications for and outcomes of knee replacement. CMAJ 1995;152:687-697
Web of Science | Medline30
Bombardier C, Klinkhoff AV, Bell M, Canadian Clinical Epidemiology Research Group. Illustrated guide to a standard examination for joint tenderness and swelling. Toronto: Merrell Dow Research Institute, 1988.
31
Callahan CM ,Drake BG ,Heck DA ,Dittus RS . Patient outcomes following tricompartmental total knee replacement: a meta-analysis. JAMA 1994;271:1349-1357
CrossRef | Web of Science | Medline32
Hosmer DW Jr, Lemeshow S. Applied logistic regression. New York: John Wiley, 1989:140.
33
1996 Census: national series tables. Ottawa, Ont.: Statistics Canada, 1997.
34
Karlson EW ,Daltroy LH ,Liang MH ,Eaton HE ,Katz JN . Gender differences in patient preferences may underlie differential utilization of elective surgery. Am J Med 1997;102:524-530
CrossRef | Web of Science | Medline35
Bergelson BA ,Tommaso CL . Gender differences in clinical evaluation and triage in coronary artery disease. Chest 1995;108:1510-1513
CrossRef | Web of Science | Medline36
Coyte PC ,Hawker GA ,Croxford R ,Attard C ,Wright JG . Variation in rheumatologists' and family physicians' perceptions of the indications for and outcomes of knee replacement surgery. J Rheumatol 1996;23:730-738
Web of Science | Medline37
Coyte PC ,Wright JG ,Hawker GA , et al. Waiting times for knee-replacement surgery in the United States and Ontario. N Engl J Med 1994;331:1068-1071
Full Text | Web of Science | Medline
- Citing Articles (128)
Citing Articles
1
Hyung Joon Cho, Chong Bum Chang, Ki Woong Kim, Joon Hyuk Park, Jae Ho Yoo, In Jun Koh, Tae Kyun Kim. (2011) Gender and Prevalence of Knee Osteoarthritis Types in Elderly Koreans. The Journal of Arthroplasty 26:7, 994-999
CrossRef2
P. Bruce Ebrahimpour, Huong T. Do, Lindsey J. Bornstein, Geoffrey H. Westrich. (2011) Relationship Between Demographic Variables and Preoperative Pain and Disability in 5945 Total Joint Arthroplasties at a Single Institution. The Journal of Arthroplasty 26:6, 133-137.e1
CrossRef3
Tracie Harrison. (2011) Burden of Restraint, Disablement, and Ethnic Identity: A Case Study of Total Joint Replacement for Osteoarthritis. Health Care for Women International 32:8, 669-685
CrossRef4
Anna-Maija Kauppila, Eero KyllÖnen, Pasi Ohtonen, Juhana Leppilahti, Harri Sintonen, Jari P. Arokoski. (2011) Outcomes of primary total knee arthroplasty: the impact of patient-relevant factors on self-reported function and quality of life. Disability and Rehabilitation 33:17-18, 1659-1667
CrossRef5
Mary I. O’Connor. (2011) Implant Survival, Knee Function, and Pain Relief After TKA: Are There Differences Between Men and Women?. Clinical Orthopaedics and Related Research® 469:7, 1846-1851
CrossRef6
Cornelia M. Borkhoff, Gillian A. Hawker, James G. Wright. (2011) Patient Gender Affects the Referral and Recommendation for Total Joint Arthroplasty. Clinical Orthopaedics and Related Research® 469:7, 1829-1837
CrossRef7
Wendy M. Novicoff, Khaled J. Saleh. (2011) Examining Sex and Gender Disparities in Total Joint Arthroplasty. Clinical Orthopaedics and Related Research® 469:7, 1824-1828
CrossRef8
Janet K. Freburger, George M. Holmes, Li-Jung E. Ku, Malcolm P. Cutchin, Kendra Heatwole-Shank, Lloyd J. Edwards. (2011) Disparities in post-acute rehabilitation care for joint replacement. Arthritis Care & Research 63:7, 1020-1030
CrossRef9
Nicholas J. London, Larry E. Miller, Jon E. Block. (2011) Clinical and economic consequences of the treatment gap in knee osteoarthritis management. Medical Hypotheses 76:6, 887-892
CrossRef10
J.R. Hochman, L. Gagliese, A.M. Davis, G.A. Hawker. (2011) Neuropathic pain symptoms in a community knee OA cohort. Osteoarthritis and Cartilage 19:6, 647-654
CrossRef11
(2011) Variability in Physician Opinions About the Indications for Knee Arthroplasty. The Journal of Arthroplasty 26:4, 569-575.e1
CrossRef12
Stephanie Brown, Gillian Hawker, Dorcas Beaton, Angela Colantonio. (2011) Long-term musculoskeletal complaints after traumatic brain injury. Brain Injury 25:5, 453-461
CrossRef13
Jonas Franklin, Thorvaldur Ingvarsson, Martin Englund, Olafur Ingimarsson, Otto Robertsson, L. Stefan Lohmander. (2011) Natural history of radiographic hip osteoarthritis: A retrospective cohort study with 11-28 years of followup. Arthritis Care & Research 63:5, 689-695
CrossRef14
S. Samuel Bederman, Peter C. Coyte, Hans J. Kreder, Nizar N. Mahomed, Warren J. McIsaac, James G. Wright. (2011) Whoʼs in the Driverʼs Seat? The Influence of Patient and Physician Enthusiasm on Regional Variation in Degenerative Lumbar Spinal Surgery. Spine 36:6, 481-489
CrossRef15
Anne Stephenson, Janet Hux, Elizabeth Tullis, Peter C. Austin, Mary Corey, Joel Ray. (2011) Higher risk of hospitalization among females with cystic fibrosis. Journal of Cystic Fibrosis 10:2, 93-99
CrossRef16
Cornelia M. Borkhoff, Mark L. Wieland, Elena Myasoedova, Zareen Ahmad, Vivian Welch, Gillian A. Hawker, Linda C. Li, Rachelle Buchbinder, Erin Ueffing, Dorcas Beaton, Mario H. Cardiel, Sherine E. Gabriel, Francis Guillemin, Ade O. Adebajo, Claire Bombardier, Najia Hajjaj-Hassouni, Peter Tugwell. (2011) Reaching those most in need: A scoping review of interventions to improve health care quality for disadvantaged populations with osteoarthritis. Arthritis Care & Research 63:1, 39-52
CrossRef17
Urs K. Munzinger, Nicola A. Maffiuletti, Thomas Guggi, Mario Bizzini, Stefan Preiss, Tomas Drobny. (2010) Five-year results of the Innex total knee arthroplasty system. International Orthopaedics 34:8, 1159-1165
CrossRef18
Atul F. Kamath, John G. Horneff, Vandy Gaffney, Craig L. Israelite, Charles L. Nelson. (2010) Ethnic and Gender Differences in the Functional Disparities after Primary Total Knee Arthroplasty. Clinical Orthopaedics and Related Research® 468:12, 3355-3361
CrossRef19
G.A. Hawker, M.R. French, E.J. Waugh, M.A.M. Gignac, C. Cheung, B.J. Murray. (2010) The multidimensionality of sleep quality and its relationship to fatigue in older adults with painful osteoarthritis. Osteoarthritis and Cartilage 18:11, 1365-1371
CrossRef20
Alma B Pedersen, Jens E Svendsson, Søren P Johnsen, Anders Riis, Søren Overgaard. (2010) Risk factors for revision due to infection after primary total hip arthroplasty. Acta Orthopaedica 81:5, 542-547
CrossRef21
Ana M. Valdes, Daniel McWilliams, Nigel K. Arden, Sally A. Doherty, Margaret Wheeler, Kenneth R. Muir, Weiya Zhang, Cyrus Cooper, Rose A. Maciewicz, Michael Doherty. (2010) Involvement of different risk factors in clinically severe large joint osteoarthritis according to the presence of hand interphalangeal nodes. Arthritis & Rheumatism 62:9, 2688-2695
CrossRef22
Rebekah L. Gardner, Richard Almeida, Judith H. Maselli, Andrew Auerbach. (2010) Does Gender Influence Emergency Department Management and Outcomes in Geriatric Abdominal Pain?. The Journal of Emergency Medicine 39:3, 275-281
CrossRef23
Anna Sansom, Jenny Donovan, Caroline Sanders, Paul Dieppe, Jeremy Horwood, Ian Learmonth, Susan Williams, Rachael Gooberman-Hill. (2010) Routes to total joint replacement surgery: Patients' and clinicians' perceptions of need. Arthritis Care & Research 62:9, 1252-1257
CrossRef24
Leslie R. M. Hausmann, Maria Mor, Barbara H. Hanusa, Susan Zickmund, Peter Z. Cohen, Richard Grant, Denise M. Kresevic, Howard S. Gordon, Bruce S. Ling, C. Kent Kwoh, Said A. Ibrahim. (2010) The Effect of Patient Race on Total Joint Replacement Recommendations and Utilization in the Orthopedic Setting. Journal of General Internal Medicine 25:9, 982-988
CrossRef25
Hyung Joon Cho, Chong Bum Chang, Jae Ho Yoo, Sung Ju Kim, Tae Kyun Kim. (2010) Gender Differences in the Correlation between Symptom and Radiographic Severity in Patients with Knee Osteoarthritis. Clinical Orthopaedics and Related Research® 468:7, 1749-1758
CrossRef26
Tamara D. Rozental. (2010) Gender-specific Issues in Orthopaedic Surgery: Editorial Comment. Clinical Orthopaedics and Related Research® 468:7, 1727-1728
CrossRef27
Maria E. Suarez-Almazor, Marsha Richardson, Tony L. Kroll, Barbara F. Sharf. (2010) A Qualitative Analysis of Decision-Making for Total Knee Replacement in Patients With Osteoarthritis. JCR: Journal of Clinical Rheumatology 16:4, 158-163
CrossRef28
P. Jüni, N. Low, S. Reichenbach, P.M. Villiger, S. Williams, P.A. Dieppe. (2010) Gender inequity in the provision of care for hip disease: population-based cross-sectional study. Osteoarthritis and Cartilage 18:5, 640-645
CrossRef29
Said A. Ibrahim. (2010) Racial variations in the use of knee and hip joint replacement: an introduction and review of the most recent literature. Current Orthopaedic Practice 21:2, 126-131
CrossRef30
Christoffer Rud-Sørensen, Alma B Pedersen, Søren Paaske Johnsen, Anders Hammerich Riis, Søren Overgaard. (2010) Survival of primary total hip arthroplasty in rheumatoid arthritis patients. Acta Orthopaedica 81:1, 60-65
CrossRef31
Stein Håkon Låstad Lygre, Birgitte Espehaug, Leif Ivar Havelin, Stein Emil Vollset, Ove Furnes. (2010) Does patella resurfacing really matter? Pain and function in 972 patients after primary total knee arthroplasty. Acta Orthopaedica 81:1, 99-107
CrossRef32
Anne-Christine Rat, Francis Guillemin, Georges Osnowycz, Jean-Pierre Delagoutte, Christian Cuny, Didier Mainard, Cédric Baumann. (2010) Total hip or knee replacement for osteoarthritis: Mid- and long-term quality of life. Arthritis Care & Research 62:1, 54-62
CrossRef33
Johan Bellemans, Karel Carpentier, Hilde Vandenneucker, Johan Vanlauwe, Jan Victor. (2010) The John Insall Award: Both Morphotype and Gender Influence the Shape of the Knee in Patients Undergoing TKA. Clinical Orthopaedics and Related Research® 468:1, 29-36
CrossRef34
Robert B. Bourne, Bert M. Chesworth, Aileen M. Davis, Nizar N. Mahomed, Kory D. J. Charron. (2010) Patient Satisfaction after Total Knee Arthroplasty: Who is Satisfied and Who is Not?. Clinical Orthopaedics and Related Research® 468:1, 57-63
CrossRef35
Lori M. Dulabon, William T. Lowrance, Paul Russo, William C. Huang. (2010) Trends in renal tumor surgery delivery within the United States. CancerNA-NA
CrossRef36
Andy Judge, Nicky J. Welton, Jat Sandhu, Yoav Ben-Shlomo. (2009) Modeling the need for hip and knee replacement surgery. Part 1. A two-stage cross-cohort approach. Arthritis & Rheumatism 61:12, 1657-1666
CrossRef37
Jasvinder A. Singh, David Lewallen. (2009) Age, gender, obesity, and depression are associated with patient-related pain and function outcome after revision total hip arthroplasty. Clinical Rheumatology 28:12, 1419-1430
CrossRef38
Robert A Fowler, Woganee Filate, Michael Hartleib, David W Frost, Chris Lazongas, Michelle Hladunewich. (2009) Sex and critical illness. Current Opinion in Critical Care 15:5, 442-449
CrossRef39
Hon-Yi Shi, Mahmud Khan, Richard Culbertson, Je-Ken Chang, Jun-Wen Wang, Herng-Chia Chiu. (2009) Health-related quality of life after total hip replacement: a Taiwan study. International Orthopaedics 33:5, 1217-1222
CrossRef40
Gillian A Hawker. (2009) Experiencing painful osteoarthritis: what have we learned from listening?. Current Opinion in Rheumatology 21:5, 507-512
CrossRef41
Wenqiang Tian, Gerben DeJong, Michael Brown, Ching-Hui Hsieh, Zvedomir P. Zamfirov, Susan D. Horn. (2009) Looking Upstream: Factors Shaping the Demand for Postacute Joint Replacement Rehabilitation. Archives of Physical Medicine and Rehabilitation 90:8, 1260-1268
CrossRef42
Gillian A. Hawker, Elizabeth M. Badley, Ruth Croxford, Peter C. Coyte, Richard H. Glazier, Jun Guan, Bart J. Harvey, J I. Williams, James G. Wright. (2009) A Population-Based Nested Case-Control Study of the Costs of Hip and Knee Replacement Surgery. Medical Care 47:7, 732-741
CrossRef43
Stavros G. Memtsoudis, Melanie C. Besculides, Shane Reid, Licia K. Gaber-Baylis, Alejandro González Della Valle. (2009) Trends in Bilateral Total Knee Arthroplasties: 153,259 Discharges between 1990 and 2004. Clinical Orthopaedics and Related Research® 467:6, 1568-1576
CrossRef44
Jinju Nishino, Sakae Tanaka, Toshihiro Matsui, Toshihito Mori, Keita Nishimura, Yoshito Eto, Atsushi Kaneko, Koichiro Saisho, Masayuki Yasuda, Noriyuki Chiba, Yasuhiko Yoshinaga, Yukihiko Saeki, Atsuhito Seki, Shigeto Tohma. (2009) Prevalence of joint replacement surgery in rheumatoid arthritis patients: cross-sectional analysis in a large observational cohort in Japan. Modern Rheumatology 19:3, 260-264
CrossRef45
Stavros G. Memtsoudis, Alejandro González Della Valle, Melanie C. Besculides, Licia Gaber, Richard Laskin. (2009) Trends in Demographics, Comorbidity Profiles, In-Hospital Complications and Mortality Associated With Primary Knee Arthroplasty. The Journal of Arthroplasty 24:4, 518-527
CrossRef46
Cornelia M. Borkhoff, Gillian A. Hawker, Hans J. Kreder, Richard H. Glazier, Nizar N. Mahomed, James G. Wright. (2009) Patients' gender affected physicians' clinical decisions when presented with standardized patients but not for matching paper patients. Journal of Clinical Epidemiology 62:5, 527-541
CrossRef47
Slavica Jandrić, Slavko Manojlović. (2009) Quality of Life of Men and Women with Osteoarthritis of the Hip and Arthroplasty. American Journal of Physical Medicine & Rehabilitation 88:4, 328-335
CrossRef48
Rachael Gooberman-Hill, Melissa French, Paul Dieppe, Gillian Hawker. (2009) Expressing pain and fatigue: A new method of analysis to explore differences in osteoarthritis experience. Arthritis & Rheumatism 61:3, 353-360
CrossRef49
Ilana N. Ackerman, Paul A. Dieppe, Lyn M. March, Ewa M. Roos, Anna K. Nilsdotter, Graeme C. Brown, Karen E. Sloan, Richard H. Osborne. (2009) Variation in age and physical status prior to total knee and hip replacement surgery: A comparison of centers in Australia and Europe. Arthritis & Rheumatism 61:2, 166-173
CrossRef50
Ilana Ackerman. (2009) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Australian Journal of Physiotherapy 55:3, 213
CrossRef51
Kevin B Fricka, William G Hamilton. (2009) Gender-specific total knee arthroplasty: a current review. Current Orthopaedic Practice 20:1, 47-50
CrossRef52
Katherine A. Boyer, Gary S. Beaupre, Thomas P. Andriacchi. (2008) Gender differences exist in the hip joint moments of healthy older walkers. Journal of Biomechanics 41:16, 3360-3365
CrossRef53
Alvin C. Jones, C. Kent Kwoh, P. W. Groeneveld, Maria Mor, Ming Geng, Said A. Ibrahim. (2008) Investigating Racial Differences in Coping with Chronic Osteoarthritis Pain. Journal of Cross-Cultural Gerontology 23:4, 339-347
CrossRef54
Stavros G. Memtsoudis, Alejandro González Della Valle, Melanie C. Besculides, Licia Gaber, Thomas P. Sculco. (2008) In-hospital Complications and Mortality of Unilateral, Bilateral, and Revision TKA: Based on an estimate of 4,159,661 Discharges. Clinical Orthopaedics and Related Research 466:11, 2617-2627
CrossRef55
Patricia D. Franklin, Wenjun Li, David C. Ayers. (2008) The Chitranjan Ranawat Award. Clinical Orthopaedics and Related Research 466:11, 2597-2604
CrossRef56
Lauren E. Cipriano, Bert M. Chesworth, Chris K. Anderson, Gregory S. Zaric. (2008) An Evaluation of Strategies to Reduce Waiting Times for Total Joint Replacement in Ontario. Medical Care 46:11, 1177-1183
CrossRef57
I. Boutron, F. Rannou, M. Jardinaud-lopez, G. Meric, M. Revel, S. Poiraudeau. (2008) Disability and quality of life of patients with knee or hip osteoarthritis in the primary care setting and factors associated with general practitioners' indication for prosthetic replacement within 1 year. Osteoarthritis and Cartilage 16:9, 1024-1031
CrossRef58
L. Gossec, J.M. Jordan, S.A. Mazzuca, M.-A. Lam, M.E. Suarez-Almazor, J.B. Renner, M.A. Lopez-Olivo, G. Hawker, M. Dougados, J.F. Maillefert. (2008) Comparative evaluation of three semi-quantitative radiographic grading techniques for knee osteoarthritis in terms of validity and reproducibility in 1759 X-rays: report of the OARSI–OMERACT task force. Osteoarthritis and Cartilage 16:7, 742-748
CrossRef59
Linda K. George, David Ruiz, Frank A. Sloan. (2008) The Effects of Total Hip Arthroplasty on Physical Functioning in the Older Population. Journal of the American Geriatrics Society 56:6, 1057-1062
CrossRef60
Jodi R. Godfrey, David T. Felson. (2008) Toward Optimal Health: Managing Arthritis in Women. Journal of Women's Health 17:5, 729-734
CrossRef61
N. Steel, A. Clark, I. A. Lang, R. B. Wallace, D. Melzer. (2008) Racial Disparities in Receipt of Hip and Knee Joint Replacements Are Not Explained by Need: The Health and Retirement Study 1998-2004. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 63:6, 629-634
CrossRef62
Peter W. Groeneveld, C. Kent Kwoh, Maria K. Mor, Cathleen J. Appelt, Ming Geng, Jennifer C. Gutierrez, Damaris S. Wessel, Said A. Ibrahim. (2008) Racial differences in expectations of joint replacement surgery outcomes. Arthritis & Rheumatism 59:5, 730-737
CrossRef63
Amresh D. Hanchate, Yuqing Zhang, David T. Felson, Arlene S. Ash. (2008) Exploring the Determinants of Racial and Ethnic Disparities in Total Knee Arthroplasty. Medical Care 46:5, 481-488
CrossRef64
A.M. Davis, A.V. Perruccio, M. Canizares, A. Tennant, G.A. Hawker, P.G. Conaghan, E.M. Roos, J.M. Jordan, J.-F. Maillefert, M. Dougados, L.S. Lohmander. (2008) The development of a short measure of physical function for hip OA HOOS-Physical Function Shortform (HOOS-PS): an OARSI/OMERACT initiative. Osteoarthritis and Cartilage 16:5, 551-559
CrossRef65
Jean Francis Maillefert, Carine Roy, Christian Cadet, Rémy Nizard, Laurent Berdah, Philippe Ravaud. (2008) Factors influencing surgeons' decisions in the indication for total joint replacement in hip osteoarthritis in real life. Arthritis & Rheumatism 59:2, 255-262
CrossRef66
Suzanne M. Cadarette, Dorcas E. Beaton, Monique A.M. Gignac, Susan B. Jaglal, Leigh Dickson, Gillian A. Hawker. (2007) Minimal error in self-report of having had DXA, but self-report of its results was poor. Journal of Clinical Epidemiology 60:12, 1306-1311
CrossRef67
Lawrence D. Dorr. (2007) Editorial Comment: Why do MIS THR?. Seminars in Arthroplasty 18:4, 222-225
CrossRef68
Johanna Hirvonen, Marja Blom, Ulla Tuominen, Seppo Seitsalo, Matti Lehto, Pekka Paavolainen, Kalevi Hietaniemi, Pekka Rissanen, Harri Sintonen. (2007) Evaluating waiting time effect on health outcomes at admission: a prospective randomized study on patients with osteoarthritis of the knee joint. Journal of Evaluation in Clinical Practice 13:5, 728-733
CrossRef69
Kenneth A. Greene. (2007) Gender-Specific Design in Total Knee Arthroplasty. The Journal of Arthroplasty 22:7, 27-31
CrossRef70
Mark D. Price, James H. Herndon. (2007) Is running good for your knees?. Menopause 14:5, 815-816
CrossRef71
Suzanne M. Cadarette, Monique A. M. Gignac, Susan B. Jaglal, Dorcas E. Beaton, Gillian A. Hawker. (2007) Access to Osteoporosis Treatment is Critically Linked to Access to Dual-Energy X-ray Absorptiometry Testing. Medical Care 45:9, 896-901
CrossRef72
H. Kapstad, T. Rustøen, B.R. Hanestad, T. Moum, N. Langeland, K. Stavem. (2007) Changes in pain, stiffness and physical function in patients with osteoarthritis waiting for hip or knee joint replacement surgery. Osteoarthritis and Cartilage 15:7, 837-843
CrossRef73
S. M. Cadarette, M. A. M. Gignac, D. E. Beaton, S. B. Jaglal, G. A. Hawker. (2007) Psychometric properties of the “Osteoporosis and You” questionnaire: osteoporosis knowledge deficits among older community-dwelling women. Osteoporosis International 18:7, 981-989
CrossRef74
Lauren E. Cipriano, Bert M. Chesworth, Chris K. Anderson, Gregory S. Zaric. (2007) Predicting joint replacement waiting times. Health Care Management Science 10:2, 195-215
CrossRef75
Haoling H. Weng, Robert M. Kaplan, W. John Boscardin, Catherine H. MacLean, Irene Y. Lee, Weiling Chen, John D. Fitzgerald. (2007) Development of a decision aid to address racial disparities in utilization of knee replacement surgery. Arthritis & Rheumatism 57:4, 568-575
CrossRef76
Agustín Escalante. (2007) Health disparities in the rheumatic diseases. Arthritis & Rheumatism 57:4, 547-552
CrossRef77
Robert L. Kane, Timothy Wilt, Maria E. Suarez-almazor, Steven S. Fu. (2007) Disparities in total knee replacements: A review. Arthritis & Rheumatism 57:4, 562-567
CrossRef78
M. Núñez, E. Núñez, J.M. Segur, F. Maculé, A. Sanchez, M V. Hernández, C. Vilalta. (2007) Health-related quality of life and costs in patients with osteoarthritis on waiting list for total knee replacement. Osteoarthritis and Cartilage 15:3, 258-265
CrossRef79
Peri J. Ballantyne, Monique A. M. Gignac, Gillian A. Hawker. (2007) A patient-centered perspective on surgery avoidance for hip or knee arthritis: Lessons for the future. Arthritis & Rheumatism 57:1, 27-34
CrossRef80
Henry Ellis, Robert Bucholz. (2007) Disparity of care in total hip arthroplasty. Current Opinion in Orthopaedics 18:1, 2-7
CrossRef81
C. Allyson Jones, Lauren A. Beaupre, D.W.C. Johnston, Maria E. Suarez-Almazor. (2007) Total Joint Arthroplasties: Current Concepts of Patient Outcomes after Surgery. Rheumatic Disease Clinics of North America 33:1, 71-86
CrossRef82
C. J. Appelt, C. J. Burant, L. A. Siminoff, C. K. Kwoh, S. A. Ibrahim. (2007) Arthritis-Specific Health Beliefs Related to Aging Among Older Male Patients With Knee and/or Hip Osteoarthritis. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 62:2, 184-190
CrossRef83
Vicky Rivard, Philippe Cappeliez. (2007) Perceived Control and Coping in Women Faced with Activity Restriction due to Osteoarthritis: Relations to Anxious and Depressive Symptoms. Canadian Journal on Aging / La Revue canadienne du vieillissement 26:03, 241
CrossRef84
Gillian A. Hawker, Jun Guan, Ruth Croxford, Peter C. Coyte, Richard H. Glazier, Bart J. Harvey, James G. Wright, Jack I. Williams, Elizabeth M. Badley. (2006) A prospective population-based study of the predictors of undergoing total joint arthroplasty. Arthritis & Rheumatism 54:10, 3212-3220
CrossRef85
Francine M. Toye, Julie Barlow, Chris Wright, Sarah E. Lamb. (2006) Personal meanings in the construction of need for total knee replacement surgery. Social Science & Medicine 63:1, 43-53
CrossRef86
D KENNEDY, S HANNA, P STRATFORD, J WESSEL, J GOLLISH. (2006) Preoperative Function and Gender Predict Pattern of Functional Recovery After Hip and Knee Arthroplasty. The Journal of Arthroplasty 21:4, 559-566
CrossRef87
William W Cross, Khaled J Saleh, Timothy J Wilt, Robert L Kane. (2006) Agreement about Indications for Total Knee Arthroplasty. Clinical Orthopaedics and Related Research 446, 34-39
CrossRef88
Olivier Bruyere, Jean-Yves Reginster. (2006) Assessment of structure-modifying drugs in osteoarthritis: surrogate or hard clinical end points?. Future Rheumatology 1:2, 199-206
CrossRef89
Sonya Borrero, C. Kent Kwoh, Jennifer Sartorius, Said A. Ibrahim. (2006) BRIEF REPORT: Gender and Total Knee/Hip Arthroplasty Utilization Rate in the VA System. Journal of General Internal Medicine 21:S3, S54-S57
CrossRef90
Gunnar B. Flugsrud, Lars Nordsletten, Birgitte Espehaug, Leif I. Havelin, Anders Engeland, Haakon E. Meyer. (2006) The impact of body mass index on later total hip arthroplasty for primary osteoarthritis: A cohort study in 1.2 million persons. Arthritis & Rheumatism 54:3, 802-807
CrossRef91
Haoling H Weng, John FitzGerald. (2006) Current issues in joint replacement surgery. Current Opinion in Rheumatology 18:2, 163-169
CrossRef92
Helen Razmjou, Richard Holtby, Terri Myhr. (2006) Gender Differences in Quality of Life and Extent of Rotator Cuff Pathology. Arthroscopy: The Journal of Arthroscopic & Related Surgery 22:1, 57-62
CrossRef93
L Stefan Lohmander, Lars Birger Engesæter, Peter Herberts, Thorvaldur Ingvarsson, Ulf Lucht, Timo J S Puolakka. (2006) Standardized incidence rates of total hip replacement for primary hip osteoarthritis in the 5 Nordic countries: similarities and differences. Acta Orthopaedica 77:5, 733-740
CrossRef94
Peter Münger, Christoph Röder, Ursula Ackermann-Liebrich, André Busato. (2006) Patient-related risk factors leading to aseptic stem loosening in total hip arthroplasty: A case-control study of 5,035 patients. Acta Orthopaedica 77:4, 567-574
CrossRef95
Lisa M. Fiksenbaum, Esther R. Greenglass, Sandra R. Marques, Judy Eaton. (2005) A psychosocial model of functional disability. Ageing International 30:3, 278-295
CrossRef96
Hilal Maradit Kremers, Megan S. Reinalda, Cynthia S. Crowson, Alan R. Zinsmeister, Gene G. Hunder, Sherine E. Gabriel. (2005) Use of physician services in a population-based cohort of patients with polymyalgia rheumatica over the course of their disease. Arthritis & Rheumatism 53:3, 395-403
CrossRef97
Sonia M. C. Pagura, Scott G. Thomas, Linda J. Woodhouse, Shereen Ezzat, Paul Marks. (2005) Circulating and synovial levels of IGF-I, cytokines, physical function and anthropometry differ in women awaiting total knee arthroplasty when compared to men. Journal of Orthopaedic Research 23:2, 397-405
CrossRef98
Brett A. Taylor, Jorge Casas-Ganem, Alexander R. Vaccaro, Alan S. Hilibrand, Brett S. Hanscom, Todd J. Albert. (2005) Differences in the Work-Up and Treatment of Conditions Associated With Low Back Pain by Patient Gender and Ethnic Background. Spine 30:3, 359-364
CrossRef99
Maxime Dougados. (2005) How can one develop disease-modifying drugs in osteoarthritis?. Current Rheumatology Reports 7:1, 22-28
CrossRef100
R Croxford, J Friedberg, PC Coyte. (2004) Socio-economic status and surgery in children: myringotomies and tonsillectomies in Ontario, Canada, 1996-2000. Acta Paediatrica 93:9, 1245-1250
CrossRef101
Gillian A. Hawker, James G. Wright, Elizabeth M. Badley, Peter C. Coyte, . (2004) Perceptions of, and willingness to consider, total joint arthroplasty in a population-based cohort of individuals with disabling hip and knee arthritis. Arthritis & Rheumatism 51:4, 635-641
CrossRef102
Kelli L. Dominick, Frank M. Ahern, Carol H. Gold, Debra A. Heller. (2004) Health-related quality of life and health service use among older adults with osteoarthritis. Arthritis & Rheumatism 51:3, 326-331
CrossRef103
John D. Fitzgerald, E. John Orav, Thomas H. Lee, Edward R. Marcantonio, Robert Poss, Lee Goldman, Carol M. Mangione. (2004) Patient quality of life during the 12 months following joint replacement surgery. Arthritis & Rheumatism 51:1, 100-109
CrossRef104
Huan J. Chang, Priya S. Mehta, Aaron Rosenberg, Susan C. Scrimshaw. (2004) Concerns of patients actively contemplating total knee replacement: Differences by race and gender. Arthritis & Rheumatism 51:1, 117-123
CrossRef105
Ray Fitzpatrick, Josephine M. Norquist, Barnaby C. Reeves, Richard W. Morris, David W. Murray, Paul J. Gregg. (2004) Equity and need when waiting for total hip replacement surgery. Journal of Evaluation in Clinical Practice 10:1, 3-9
CrossRef106
Suzanne M. Cadarette, Dorcas E. Beaton, Gillian A. Hawker. (2004) Osteoporosis Health Belief Scale: Minor changes were required after telephone administration among women. Journal of Clinical Epidemiology 57:2, 154-166
CrossRef107
M. Kathleen Figaro, Pamela Williams Russo, John P. Allegrante. (2004) Preferences for Arthritis Care Among Urban African Americans: "I Don't Want to Be Cut".. Health Psychology 23:3, 324-329
CrossRef108
Pascal Richette, Thomas Bardin. (2004) Structure-modifying agents for osteoarthritis: an update. Joint Bone Spine 71:1, 18-23
CrossRef109
Jean-Francis Maillefert, Maxime Dougados. (2003) Is time to joint replacement a valid outcome measure in clinical trials of drugs for osteoarthritis?. Rheumatic Disease Clinics of North America 29:4, 831-845
CrossRef110
J Mark Wilkinson, A Gerard Wilson, Ian Stockley, Ian R Scott, David A Macdonald, Andrew J Hamer, Gordon W Duff, Richard Eastell. (2003) Variation in the TNF Gene Promoter and Risk of Osteolysis After Total Hip Arthroplasty. Journal of Bone and Mineral Research 18:11, 1995-2001
CrossRef111
A.M. Davis, E.M. Badley, D.E. Beaton, J. Kopec, J.G. Wright, N.L. Young, J.I. Williams. (2003) Rasch analysis of the western ontariomcmaster (WOMAC) osteoarthritis index: results from community and arthroplasty samples. Journal of Clinical Epidemiology 56:11, 1076-1083
CrossRef112
Skinner, Jonathan, Weinstein, James N., Sporer, Scott M., Wennberg, John E., . (2003) Racial, Ethnic, and Geographic Disparities in Rates of Knee Arthroplasty among Medicare Patients. New England Journal of Medicine 349:14, 1350-1359
Full Text113
C Mancuso. (2003) Patients with poor preoperative functional status have high expectations of total hip arthroplasty. The Journal of Arthroplasty 18:7, 872-878
CrossRef114
F Weaver. (2003) Preoperative risks and outcomes of hip and knee arthroplasty in the veterans health administration ,. The Journal of Arthroplasty 18:6, 693-708
CrossRef115
Ann M. O'Hare, R. Adams Dudley, Denise M. Hynes, Charles E. Mcculloch, Daniel Navarro, Philip Colin, Kevin Stroupe, Joseph Rapp, Kirsten L. Johansen. (2003) Impact of surgeon and surgical center characteristics on choice of permanent vascular access. Kidney International 64:2, 681-689
CrossRef116
Dorothy D. Dunlop, Jing Song, Larry M. Manheim, Rowland W. Chang. (2003) Racial Disparities in Joint Replacement Use Among Older Adults. Medical Care 41:2, 288-298
CrossRef117
Jiri Chard, Paul Dieppe. (2002) Update: Treatment of osteoarthritis. Arthritis & Rheumatism 47:6, 686-690
CrossRef118
Gillian A. Hawker, James G. Wright, Richard H. Glazier, Peter C. Coyte, Bart Harvey, J. Ivan Williams, Elizabeth M. Badley. (2002) The effect of education and income on need and willingness to undergo total joint arthroplasty. Arthritis & Rheumatism 46:12, 3331-3339
CrossRef119
Amy K. Alderman, Kevin C. Chung, Sonya Demonner, Sandra V. Spilson, Rodney A. Hayward. (2002) The rheumatoid hand: A predictable disease with unpredictable surgical practice patterns. Arthritis & Rheumatism 47:5, 537-542
CrossRef120
Maria E. Suarez-Almazor. (2002) Unraveling Gender and Ethnic Variation in the Utilization of Elective Procedures. Medical Care 40:6, 447-450
CrossRef121
Jeremy Holtzman, Khal Saleh, Robert Kane. (2002) Gender Differences in Functional Status And Pain in a Medicare Population Undergoing Elective Total Hip Arthroplasty. Medical Care 40:6, 461-470
CrossRef122
Dennis C. Ang, Said A. Ibrahim, Chris J Burant, Laura A. Siminoff, C. Kent Kwoh. (2002) Ethnic Differences in the Perception of Prayer and Consideration of Joint Arthroplasty. Medical Care 40:6, 471-476
CrossRef123
Agustín Escalante, Jane Barrett, Inmaculada del Rincón, John E. Cornell, Charlotte B. Phillips, Jeffrey N. Katz. (2002) Disparity in Total Hip Replacement Affecting Hispanic Medicare Beneficiaries. Medical Care 40:6, 451-460
CrossRef124
Marieke Ostendorf, Olof Johnell, Henrik Malchau, Wouter J A Dhert, Augustinus J P Schrijvers, Abraham J Verbout. (2002) The epidemiology of total hip replacement in the Netherlands and Sweden. Acta Orthopaedica 73:3, 282-286
CrossRef125
J Lieberman. (2001) Hip function in patients >55 years old Population reference values. The Journal of Arthroplasty 16:7, 901-904
CrossRef126
Gillian A. Hawker, James G. Wright, Peter C. Coyte, J. Ivan Williams, Bart Harvey, Richard Glazier, Annette Wilkins, Elizabeth M. Badley. (2001) Determining the Need for Hip and Knee Arthroplasty: The Role of Clinical Severity and Patients??? Preferences. Medical Care 39:3, 206-216
CrossRef127
Peri J. Ballantyne, Gillian A. Hawker, Detelina Radoeva. 2001. The extended self: Illness experiences of older married arthritis sufferers. , 261-282.
CrossRef128
Charlson, Mary E., , Allegrante, John P., . (2000) Disparities in the Use of Total Joint Arthroplasty. New England Journal of Medicine 342:14, 1044-1045
Full Text
