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

Authors

  • Gretl A. McHugh PhD,

    Corresponding author
    1. Research Fellow, School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
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  • Malcolm Campbell PhD,

    1. Lecturer in Statistics, School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
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  • Alan J. Silman FMedSci MD,

    1. Professor of Rheumatic Disease Epidemiology, School of Epidemiology and Health Sciences, The University of Manchester, Manchester, UK
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  • Peter R. Kay FRCS,

    1. Consultant Orthopaedic Surgeon, Department of Orthopaedics, Wrightington, Wigan and Leigh NHS Trust, Wrightington Hospital, Wigan, Lancashire, UK
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  • Karen A. Luker FMedSci PhD

    1. Professor of Community Nursing, School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
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Dr Gretl A. McHugh
School of Nursing, Midwifery and Social Work
The University of Manchester
Oxford Road
Manchester M13 9PL
UK
E-mail: gretl.mchugh@manchester.ac.uk

Abstract

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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