Journal of General Internal Medicine

, Volume 21, Supplement 3, pp S54–S57 | Cite as

Brief report: Gender and total knee/hip arthroplasty utilization rate in the VA system

  • Sonya Borrero
  • C. Kent Kwoh
  • Jennifer Sartorius
  • Said A. Ibrahim
Original Articles


OBJECTIVE: Osteoarthritis (OA) is a leading cause of disability and is more prevalent in women than men. Total joint arthroplasty is an effective treatment option for end-stage OA. We examined gender differences in utilization rates of total knee/hip arthroplasty in the Veterans Administration (VA) system.

METHODS: The sample consisted of all VA patients for fiscal year (FY) 1999, 50 years of age or older, with or without the diagnosis of OA in any joint. We calculated the odds of patients undergoing total knee/hip arthroplasty adjusting for age, comorbidities, and presence of OA. We included the hospital site as a random effects variable to adjust for clustering.

RESULTS: Of the 1,968,093 (2.3% women) VA patients in FY 1999 who were 50 years of age or older, 329,461 (2.9% women) patients carried a diagnosis of OA. For women, 2-year adjusted odds of undergoing total knee or hip arthroplasty were 0.97 (0.83 to 1.14) and 1.00 (0.79 to 1.27), respectively.

CONCLUSION: Among patients potentially at risk for the procedure, men and women in the VA system were equally likely to undergo knee/hip arthroplasty.

Key words

osteoarthritis gender arthroplasty Veterans Administration 


  1. 1.
    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 edn. Philadelphia: W.B. Saunders; 1992:15–37.Google Scholar
  2. 2.
    Lawrence RC, Helmick CG, Arnett FC, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998;41:778–99.PubMedCrossRefGoogle Scholar
  3. 3.
    Jones CA, Voaklander DC, Johnston DW, Suarez-Almazor ME. Health-related quality of life outcomes after total hip and knee arthroplasties in a community-based population. J Rheumatol. 2000;27:1745–52.PubMedGoogle Scholar
  4. 4.
    Ayanian JZ, Epstein AM. Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med. 1991;325:221–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Tobin JN, Wassertheil-Smolter S, Wexler JD, et al. Sex bias in considering coronary bypass surgery. Ann Intern Med. 1997;107:19–25.CrossRefGoogle Scholar
  6. 6.
    Bloembergen WE, Mauger EA, Wolfe RA, Port FK. Association of gender and access to cadaveric renal transplantation. Am J Kidney Dis. 1997;30:733–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Hawker GA, Wright JG, Coyte PC, et al. Differences between men and women in the rate of use of hip and knee arthroplasty. N Engl J Med. 2000;342:1016–22.PubMedCrossRefGoogle Scholar
  8. 8.
    Katz BP, Freund DA, Heck DA, et al. Demographic variation in the rate of knee replacement: a multi-year analysis. Health Services Res. 1996;31:125–40.Google Scholar
  9. 9.
    Baron BJ, Barrett J, Katz JN, Liang MH. Total hip arthroplasty: use and select complications in the U.S. Medicare population. Am J Public Health. 1996;86:70–2.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Giacomini M. Gender and ethnic differences in hospital based procedure utilization in California. Arch Intern Med. 1996;156:1217–24.PubMedCrossRefGoogle Scholar
  11. 11.
    Quam JP, Michet CJ, Wilson MG, et al. Total knee arthroplasty: a population based study. Mayo Clin Proc. 1991;156:589–95.CrossRefGoogle Scholar
  12. 12.
    Madhok R, Lewallen DG, Wallrichs SL, Ilstrup DM, Kurland RL, Melton L Jr. Trends in the utilization of primary total hip arthroplasty 1969–90: a population-based study in Olmstead County. Minnesota. Mayo Clin Proc. 1993;68:11–8.CrossRefGoogle Scholar
  13. 13.
    Melton L Jr., Stauffer RN, Chao EY, Ilstrup DM. Rates of total hip arthroplasty: a population based study. N Engl J Med. 1982;307:1242–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Mahomed N, Barrett J, Katz JN, Baron JA, Wright J, Losina E. Epidemiology of total knee replacement in the United States Medicare population. J Bone Joint Surg Am. 2005;87:1222–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Kelly KD, Voaklander DC, Johnston WC, Suarez-Almazor ME. Equity in waiting times for major joint arthroplasty. Can J Surg. 2002;45:269–76.PubMedCentralPubMedGoogle Scholar
  16. 16.
    Escalante A, Barrett J, del Rincon I, Cornell JE, Phillips CB, Katz JN. Disparity in total hip replacement affecting Hispanic Medicare beneficiaries. Med Care. 2002;40:451–60.PubMedCrossRefGoogle Scholar
  17. 17.
    Wilson NJ, Kizer KW. The VA health care system: an unrecognized national safety net. Health Aff. 1997;16:200–4.CrossRefGoogle Scholar
  18. 18.
    Holtzman J, Saleh K, Kane R. Gender differences in functional status and pain in a Medicare population undergoing elective total hip arthroplasty. Med Care. 2002;40:461–70.PubMedCrossRefGoogle Scholar
  19. 19.
    Fortin PR, Penrod JR, Clarke AE, et al. Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthritis Rheum. 2002;46:3327–30.PubMedCrossRefGoogle Scholar
  20. 20.
    Karlson EW, Dultroy LH, Liang MH, Eaton HE, Katz JN. Gender differences in patient preferences may underlie differential utilization of elective surgery. Am J Med. 1997;102:524–30.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • Sonya Borrero
    • 1
  • C. Kent Kwoh
    • 1
    • 2
  • Jennifer Sartorius
    • 2
  • Said A. Ibrahim
    • 1
    • 2
  1. 1.School of MedicineUniversity of PittsburghPittsburghUSA
  2. 2.Center for Health Equity Research and Promotion (151-C)VA Pittsburgh Health Care SystemPittsburgh

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