ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2008
The effect of patients' sex on physicians' recommendations for total knee arthroplasty.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 90 papers, 5 of them syntheses that pooled it.
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Who cites it
90 citing papers in PubMed, 5 syntheses or guidelines pooled it, 251 citations in OpenAlex.
- Gender equality challenges in orthopaedic surgery: a systematic review.International orthopaedics · 2023Pooled it
- Sex-specific differences in children attending the emergency department: prospective observational study.BMJ open · 2020Pooled it
- Doubly blind: a systematic review of gender in randomised controlled trials.Global health action · 2016Pooled it
- Determinants of demand for total hip and knee arthroplasty: a systematic literature review.BMC health services research · 2012Pooled it
- Patient gender affects the referral and recommendation for total joint arthroplasty.Clinical orthopaedics and related research · 2011Pooled it
- Trial
- Do patient race and sex change surgeon recommendations for TKA?Clinical orthopaedics and related research · 2015Trial
- Gender-Based Differences in Arthroplasty Utilization Across Two Tertiary Academic Centers.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2026Article
- Social and Demographic Health Disparities in Knee Osteoarthritis and Total Knee Arthroplasty.Arthroplasty today · 2026Review
- Striving for LGBTQI+ Health Equity in Arthroplasty.Arthroplasty today · 2026Article
- What Are the Determinants of the Sex/Gender Difference in Duration of Work Absence for Musculoskeletal Disorders? A Mixed-Studies Systematic Review.Healthcare (Basel, Switzerland) · 2025Review
- How can we promote gender and sex equality in orthopaedics and traumatology surgery? Research avenues perspectives.Journal of orthopaedic surgery and research · 2025Review
- Lack of sex bias in the referral letters for patients with inflammatory bowel disease: a mixed methods evaluation.Journal of the Canadian Association of Gastroenterology · 2025Article
- Why should orthopaedic surgeons strive to improve diversity in our specialty?International orthopaedics · 2024Article
- Anatomical Features in Inguinal-Pubic-Adductor Area That May Contribute to Gender Difference in Susceptibility to Groin Pain Syndrome.Journal of personalized medicine · 2024Review
- Health consequences of structural sexism: Conceptual foundations, empirical evidence and priorities for future research.Social science & medicine (1982) · 2024Review
- Differences in preoperative frailty assessment of surgical candidates by sex, age, and race.Surgery open science · 2024Article
- Disparities Exist in the Experience of Financial Burden Among Orthopedic Trauma Patients: A Systematic Review.Current reviews in musculoskeletal medicine · 2024Review
- Sex-based Differences in Patient Perspectives and Experiences With Shoulder, Hip, and Knee Arthroplasty.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2024Article
- Structural Sexism and Preventive Health Care Use in the United States.Journal of health and social behavior · 2024Article
30 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
6 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe 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.
methodsSeventy-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.
resultsIn 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.
interpretationPhysicians 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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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.