Patients waiting for a hip or knee joint replacement: is there any prioritization for surgery?

Gretl A McHugh, Malcolm Campbell, Alan J Silman, Peter R Kay, Karen A Luker
Journal of Evaluation in Clinical Practice 2008, 14 (3): 361-7

OBJECTIVE: To investigate whether patients are prioritized for joint replacement surgery on the basis of severity of osteoarthritis, pain and physical functioning.

METHOD: A total of 105 patients on the waiting list for primary total knee or hip replacement from a UK regional orthopaedic centre were interviewed at baseline and followed up at 3, 6 and 9 months or until joint replacement. Measurement tools were the visual analogue scale (VAS), Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and the Oxford hip or knee score.

RESULTS: Most participants (81, 77%) were categorized on the waiting list as 'routine', despite having high levels of pain according to the measurement scales. There was no significant correlation between the waiting list categorization and the actual waiting time for a hip or knee joint replacement operation (Kendall's tau = 0.17; P = 0.062) and the waiting list categorization did not appear to ensure that patients were operated upon earlier. There were also no significant differences in measures (VAS pain, WOMAC and Oxford hip or knee scores) between those individuals who had their operations earlier (before 6 months) compared with those participants who had their operations later (6 months or greater) or even not at all. Of the 105 patients who were listed for joint replacement, 24 (25%) patients did not have their operation due to: a medical delay (14); self-delay/cancellation (7); arthroscopy instead (2); and death (1).

CONCLUSION: With the expected increase in demand for joint replacement, there needs to be a re-examination of assessment procedures of patients listed for joint replacement. The use of measurement tools to assess symptoms such as pain and physical function would be one way forward.

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