Women appear to delay knee replacement surgery longer than men, and often show up far more disabled by the time they undergo the procedure.

How long can you stand the pain?

The gender differences among knee replacement candidates is cause for concern because far more women than men suffer from osteoarthritis, which can wear down the cartilage in knees and leave sufferers with bone-on-bone rubbing and agonizing pain. Patients are typically advised to delay knee replacement as long as possible because titanium knee parts eventually wear out too. By delaying the treatment, the patient ideally will die a natural death before replaced knees wear out again.

“This is the exact advice I was given when I visited my new orthopedic surgeon in March 2008.”

Dr. Andrew Simpson @ Carter Orthopedics and Sports Medicine in Wilmington North Carolina

Dr. Simpson advised me that he felt I was too young [at age 48] to undergo TKR suregery and I should try to wait it out as long as I possibly could OR wait until I blew out my knee before having the surgery.

So we opted for corticosteroid injection [rt knee only] and aquatic therapy.

Within 3 months everything changed…I turned 49, aqua therapy had little to no effect good or bad and the injection gave me a 4 day respite from the constant pain.

On the 2nd visit Dr Simpson told me I had 2 choices. [1] Have the surgery IF I proved to be a good candidate [which has not yet been determined] or [2] spend the rest of my life in a wheelchair.

But doctors now say they may need to rethink that advice because women appear to take it to the extreme.

In a study published in The Journal of Bone and Joint Surgery last fall, University of Delaware researchers studied 95 men and 126 women who were about to undergo knee replacement surgery. All of the patients took part in various tests to measure such activities as climbing stairs, walking and getting out of a chair. They also compared them to similarly-aged men and women who didn’t have knee problems.

They found that even after controlling for expected gender differences in strength and agility, the women had reached far higher levels of impairment before opting for surgery than the men had, said Lynn Snyder-Mackler, professor in the department of physical therapy at the University of Delaware.

“Does that mean men are wimps? Does it mean that women are predisposed to better deal with intense pain?”

“If your surgeon is telling you, ‘Wait until you can’t stand it anymore,’ most men will decide that is the point when they can’t really get out of the house anymore,’’ Dr. Snyder-Mackler said. “A lot of the women didn’t make that decision until they were unable to function inside the house.’’

The problem is that if a patient waits too long for the procedure, she will have a more difficult recovery and is less likely to regain full function. “How much dysfunction you have when you have knee replacement predicts how well you’re going to do,’’ Dr. Snyder-Mackler said. “The more debilitated you are at the start, there is a point of diminishing returns.’’

“So? How long is TOO long??”

The lesson for doctors is to rethink whether to tell patients to wait until they can’t stand the pain. “We’re throwing up a warning light that this type of instruction to women is making them wait too long,’’ Dr. Snyder-Mackler said. “If they are having difficulty with stairs and difficulty getting out of the house and around, if they’ve become housebound, they better get their knee replaced. You don’t wait to become completely debilitated because it’s very hard to get that back.’’

“I have other contributing factors, like; my legs have bowed, I have severe neuropathy of the feet, I have chronic long-term Lyme Disease, I am a diabetic, I am already in a wheelchair.”

“My surgeon has recommended seeing an Infectious Disease EXPERT prior to making a decision on the surgery, and he wants a consultation between himself, the Infectious Disease Doc and my Primary before we make a decision about surgery, because I don’t JUST need my right knee done, I also need my left knee done.”