Copyright © 2007 by The Journal of Bone and Joint Surgery, Inc.
Commentary & Perspective
Commentary & Perspective by
Charles R. Clark, MD*,
University of Iowa, Iowa City, Iowa
Posted November 2007
In this study, the authors found that women have a higher
risk of the development of osteoarthritis and have higher rates of disability
attributable to that disease. The authors believe that it is important to understand
the impact of gender on disease and osteoarthritis-related impairment in
arthroplasty candidates. I totally agree.
The authors used physical performance measures to assess how
gender affects the type and magnitude of osteoarthritis-related impairment in
arthroplasty candidates. The authors are aware of only one prior study on the
topic, but that study was limited by the lack of a comparison group and because
measurements of lower-extremity muscle strength were not reported1.
The present study includes 221 individuals (ninety-five men
and 126 women). Multiple physical performance measures were analyzed. The
authors found that women in the arthroplasty group had lower SF-36 physical
component scores and Knee Outcome Survey scores in comparison with men,
indicating greater reported disability. Women in both the control group and the
arthroplasty group had significantly lower quadriceps normalized maximal volitional
isometric contraction (p < 0.001) even when adjusting for age and body size.
Furthermore, they found that gender-specific differences were magnified in
arthroplasty candidates. Their data support the concept that gender-specific
differences in strength and function are inherent. In addition, their data
suggest that women are more adversely affected by osteoarthritis than men are
and that women undergo arthroplasty later in the degenerative process than men
do. Therefore, the timing of total knee arthroplasty may be important in terms
of optimizing outcome.
The authors acknowledge that there are limitations to the
study. Osteoarthritis of the contralateral knee was not evaluated, and the
duration of symptoms in the involved knee was not recorded. They point out that
future research should assess the impact of gender-specific differences longitudinally
from the onset of symptoms to the time of total knee arthroplasty.
The impact of gender in total knee arthroplasty is a timely
topic; however, there is little objective data in this regard. This study adds
to our knowledge in an important way because it provides objective measures of
performance. Knowledge of these gender-specific differences may be particularly
important when counseling patients with regard to surgical decision-making because
female patients may benefit from earlier surgical intervention. Strength and
functional decline should be closely monitored in female patients with
osteoarthritis of the knee. A delay in the surgical treatment of osteoarthritis
of the knee in women may be associated with a less than optimal outcome. This
study provides clinically useful information to help guide the orthopaedic surgeon
with regard to the decision-making process related to the surgical management
of women with osteoarthritis of the knee.
*The author did not receive any outside funding or grants in
support of his research for or preparation of this work. Neither he nor a
member of his immediate family received payments or other benefits or a
commitment or agreement to provide such benefits from a commercial entity. No
commercial entity paid or directed, or agreed to pay or direct, any benefits to
any research fund, foundation, division, center, clinical practice, or other
charitable or nonprofit organization with which the author, or a member of his
immediate family, is affiliated or associated.
Reference
1. Kennedy D, Stratford PW, Pagura SM, Walsh M, Woodhouse LJ. Comparison of gender and group differences in self-report and physical performance measures in total hip and knee arthroplasty candidates. J Arthroplasty. 2002;17:70-7.
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