Department of Orthopaedic Surgery, Mayo Clinic Florida, 4500 San Pablo Road South, Jacksonville, FL 32224, USA.
Clin Orthop Relat Res. 2011 Jul;469(7):1883-5. doi: 10.1007/s11999-010-1743-4.
Biologically derived (sex-based) and behaviorally influenced (gender-based) disparities exist in knee osteoarthritis and treatment with TKA.
QUESTIONS/PURPOSES: We sought to highlight sex- and gender-based differences with respect to knee osteoarthritis and its treatment. Our purposes were to (1) define where we are now, (2) outline where we need to go, and (3) generate solutions to how we can get there. WHERE ARE WE NOW?: A growing body of evidence shows sex- and gender-based disparities contribute to differences in the incidence, treatment, and outcomes of patients with knee osteoarthritis. Moreover, the influence of unconscious provider bias in disparities in care is becoming recognized. WHERE DO WE NEED TO GO?: Sex- and gender-based differences need to be identified and translated into clinical practice to effect patient-centered sex- and gender-based medicine. Equitable and evidence-based care must be provided. HOW DO WE GET THERE?: Research must continue to focus on sex-based differences in cartilage degeneration and gender-related factors influencing the development and progression of knee osteoarthritis. Development of evidence-based guidelines for optimal timing of TKA would assist patients and clinicians with surgical decision-making. Training of healthcare providers to mitigate again unconscious basis is essential. Care must be patient-focused, with patients empowered to be full partners with providers in healthcare outcomes.
在膝关节骨关节炎和全膝关节置换术(TKA)治疗中,存在生物学来源(基于性别的)和行为影响(基于性别的)的差异。
问题/目的:我们旨在强调膝关节骨关节炎及其治疗方面的性别差异。我们的目的是(1)定义我们现在所处的位置,(2)概述我们需要去的地方,以及(3)提出如何到达那里的解决方案。
我们现在在哪里?越来越多的证据表明,性别差异导致了膝关节骨关节炎患者在发病率、治疗和结局方面的差异。此外,人们开始认识到,无意识的提供者偏见在护理中的差异也会造成影响。
我们需要去哪里?需要确定性别差异,并将其转化为以患者为中心的性别医学的临床实践。必须提供公平和基于证据的护理。
我们如何到达那里?研究必须继续关注软骨退变中的性别差异,以及影响膝关节骨关节炎发生和进展的性别相关因素。制定 TKA 最佳时机的基于证据的指南将有助于患者和临床医生做出手术决策。培训医疗保健提供者以减轻无意识的偏见至关重要。护理必须以患者为中心,使患者能够在医疗保健结果中成为提供者的完全合作伙伴。