Women are disproportionately impacted by knee & hip osteoarthritis (OA): why does this happen and how can we address it?
- Women experience a disproportionate OA burden compared to men, including higher rates of OA & pain & worse functional ability.
- Greatest risk factor for knee OA in females (16–45 years) is a traumatic knee injury, particularly to the anterior cruciate ligament (ACL).
- OA is evident on xray in 50% of knees within 10 years after traumatic knee injury.
- Women experience worse self-reported symptoms & reduced activity after ACL injury compared to men.
- Greatest risk factor for hip OA in young women is insidious, that is developmental dysplasia of the hip (DDH). DDH has a prevalence of up to 20% of children/adolescents, 80% of those female.
- DDH sufferers have pain impacting sleep, work, sport, exercise & social activities.
- Knee & hip OA in females – (Australian statistics)- growth in annual knee injury incidence among girls/women (3.0% per year) compared with boys/ men (1.3% per year).
- Women’s ACL injury rates are projected to increase, partly due to ↑ sports participation, up to 8X higher risk of ACL injury, & impact of gendered environmental factors.
- Post-traumatic knee OA – consider this burden at a time when young women have high occupational & parental responsibilities.
- Young people with DDH are 5X more likely to develop total hip replacement by 35 years than those without DDH.
- Preventing or reducing knee OA in young women with ACL injuries requires addressing gender-specific barriers in rehabilitation. Factors like access to healthcare, financial constraints, social support, & cultural norms affect participation & outcomes.
- Current rehabilitation approaches fail to consider women’s unique physical, psychological, & social challenges. Research is needed to understand these barriers, involve women with ACL injuries in study design, & develop targeted interventions.
- For hip OA prevention in young women with DDH, the gold-standard treatment is periacetabular osteotomy (PAO), which improves hip stability but has a long recovery time & potential complications. Exercise therapy may offer a lower-risk alternative, but its effectiveness in preventing OA is unclear. Further research is needed to explore how surgery or exercise can modify joint loading & slow OA progression, with a focus on long-term solutions co-designed with affected women.
A new approach to care is essential—one that prioritises early detection, gender-specific rehabilitation, & co-designed interventions with women affected by ACL injuries & DDH. Without intervention, young women will continue to face a high risk of severe knee & hip OA, leading to joint replacements before age 40. Evidence-based solutions are needed to reduce this burden, enabling women to stay active, fulfill work & caregiving roles, & age healthily. Investing in research & targeted solutions will not only improve women’s long-term health but also reduce the economic burden of early joint replacements on the healthcare system.
