title: Differences between men and women undergoing major orthopedic surgery for degenerative arthritis.
abstract: OBJECTIVE
  To determine whether women have worse functional status than men at the time of laminectomy for degenerative spinal stenosis or total joint arthroplasty for degenerative arthritis of the hip and knee.
  
  
  METHODS
  Consecutive patients undergoing laminectomy for degenerative lumbar spinal stenosis or unilateral, primary hip or knee arthroplasty for advanced degenerative arthritis were recruited. Functional status was measured with self-administered questionnaires. We compared preoperative functional status scores of men and women, using linear regression models that adjusted for age, comorbid conditions, work status, education, living arrangement, and body mass index. We also compared the rates of in-hospital complications and 6-month followup functional status scores for men and women.
  
  
  RESULTS
  Women had much worse functional status than men prior to laminectomy for spinal stenosis (P < 0.01) and prior to total hip arthroplasty (P < 0.001) and total knee arthroplasty (P < 0.0001). These differences persisted after statistical adjustment for demographic and clinical characteristics. Women had comparable or greater functional improvement following surgery and experienced a similar number of complications compared with men.
  
  
  CONCLUSIONS
  The observed gender differences in functional status prior to major orthopedic surgery indicate that women are operated on at a more advanced stage in the course of their disease. These results are not due to gender differences in demographic or clinical characteristics of the patients, and cannot be justified by differences between men and women in the outcome of surgery. The role of patient preferences and differential access to these procedures should be explored in future studies.
authors.affiliation: Department of Rheumatology and Immunology, Brigham and Women's Hospital, Boston, MA 02115.
authors.forename: J N
authors.initials: JN
authors.lastname: Katz
authors.forename: E A
authors.initials: EA
authors.lastname: Wright
authors.forename: E
authors.initials: E
authors.lastname: Guadagnoli
authors.forename: M H
authors.initials: MH
authors.lastname: Liang
authors.forename: E W
authors.initials: EW
authors.lastname: Karlson
authors.forename: P D
authors.initials: PD
authors.lastname: Cleary
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D015994:Incidence; D007720:Knee Prosthesis; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009985:Orthopedics; D010003:Osteoarthritis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000534:rehabilitation; D012737:Sex Factors; D013130:Spinal Stenosis / Q000601:surgery; D011795:Surveys and Questionnaires; D016896:Treatment Outcome