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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Musculoskeletal Disorders 1/2015

Reducing gender disparities in post-total knee arthroplasty expectations through a decision aid

BMC Musculoskeletal Disorders > Ausgabe 1/2015
Elizabeth R Volkmann, John D FitzGerald
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12891-015-0473-x) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

JDF conceived the study and participated in its design and coordination and helped to draft the manuscript. ERV performed the statistical analysis and drafted the manuscript. Both authors read and approved the final manuscript.

Authors’ information

JDF is the Chief of Rheumatology at UCLA. He is a health services researcher who has focused on policy analysis for orthopaedic procedures. ERV is a clinical instructor in the Rheumatology Division at UCLA and has a Master Degree in Clinical Research.



Gender disparities in total knee arthroplasty utilization may be due to differences in perceptions and expectations about total knee arthroplasty outcomes. This study evaluates the impact of a decision aid on perceptions about total knee arthroplasty and decision-making parameters among patients with knee osteoarthritis.


Patients with moderate to severe knee osteoarthritis viewed a video about knee osteoarthritis treatments options, including total knee arthroplasty, and received a personalized arthritis report. An adapted version of the Western Ontario and McMaster Universities Osteoarthritis Index was used to assess pain and physical function expectations following total knee arthroplasty before/after the intervention. These scores were compared to an age- and gender-adjusted means for a cohort of patients who had undergone total knee arthroplasty. Decision readiness and conflict were also measured.


At baseline, both men and women had poorer expectations about post-operative pain and physical outcomes compared with observed outcomes of the comparator group. Following the intervention, women’s mean age-adjusted expectations about post- total knee arthroplasty pain outcomes improved (Pre: 27.0; Post: 21.8 [p =0.08; 95% CI −0.7, 11.0]) and were closer to observed post-TKA outcomes; whereas men did not have a significant change in their pain expectations (Pre: 21.3; Post: 19.6 [p = 0.6; 95% CI −5.8, 9.4]). Women also demonstrated a significant improvement in decision readiness; whereas men did not. Both genders had less decision conflict after the intervention.


Both women and men with osteoarthritis had poor estimates of total knee arthroplasty outcomes. Women responded to the intervention with more accurate total knee arthroplasty outcome expectations and greater decision readiness. Improving patient knowledge of total knee arthroplasty through a decision aid may improve medical decision-making and reduce gender disparities in total knee arthroplasty utilization.
Additional file 1: Personalized arthritis report on pain. Example of a personalized arthritis report describing how a male participant’s current pain symptoms compared to gender- and age-adjusted pre-operative mean pain score for patients who had undergone. TKA.
Additional file 2: Personalized arthritis report on physical function. Example of a personalized arthritis report describing how a male participant’s current physical function impairments compared to gender- and age-adjusted pre-operative mean physical function score for patients who had undergone TKA.
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