A new study has confirmed what orthopaedic surgeons have long suspected – that waiting for longer than six months for a total hip or knee replacement has a big impact on a patient’s quality of life.
Edinburgh University study
The cross-sectional multicentre study from the University of Edinburgh, which was published in The Bone and Joint Journal, set out to explore whether health-related quality of life was affected if patients have to wait six months or longer for their hip or knee replacement surgery. The research team also looked at changes in frailty and the number of patients considered to be living in a state categorised as ‘worse than death’ in healthcare studies.
What the researchers did
They considered 326 patients – 150 men and 176 women, with an average age of 68.6. The patients studied were randomly selected from waiting lists at four different settings. All had been waiting for six months or longer and the average wait was 13 months. The researchers used standard tools to assess the patients’ quality of life, including: the EuroQol five-dimension questionnaire and visual analogue scores, the Rockwood Clinical Frailty Scale and the 36-item Short Form Survey subjective change in health-related quality of life. Patients were asked to assess how they were at the time and compare this to six months earlier. The term ‘worse than death’ was applied if patients reported an EuroQol five-dimensional questionnaire quality of life score of less than zero. This is used to evaluate five elements of quality of life – mobility, self-care, usual activities, pain/discomfort and anxiety/depression.
Research findings
The researchers found there were significant deteriorations in both the EuroQol and visual analogue scores. Patients awaiting a total hip replacement saw a greater deterioration in their Clinical Frailty Score compared to those awaiting a knee replacement. There was a significant deterioration from a CFS of 3 (‘managing well’) to 4 (‘vulnerable’) during the six months they were awaiting surgery. Two thirds of patients said their health had worsened over that same period and, most worryingly, the number of patients in a state categorised as ‘worse than death’ had doubled. Patients awaiting a total hip replacement had worse quality of life than those awaiting a knee replacement and were more likely to be living in a state ‘worse than death’.
Impact of deteriorating quality of life
A worse health-related quality of life score is not only distressing and uncomfortable for patients, but it is also associated with a longer length of stay in hospital, increased perioperative complications and a greater risk of mortality. Patients may not fully recover from the deterioration in their quality of life while waiting for surgery even after the joint replacement has taken place.
Private healthcare
With healthcare systems around the world continuing to struggle to bring down waiting lists following the pandemic, it is understandable that more patients than ever, who are able to, are turning to private healthcare providers for joint replacement surgery. The options include private healthcare insurance or self-pay and patients are able to receive diagnostic tests and a treatment plan within a timescale that suits them.
Alternatives to surgery
In some cases, patients may be able to delay the need for surgery by having less invasive procedures such as physiotherapy or injections of corticosteroids into the affected joint to reduce swelling and inflammation. Delaying joint replacement surgery for as long as possible is beneficial as prosthetic implants do eventually wear out, so this reduces the chances of needing further revision surgery at a later date.
However, it is a careful balancing act because – as the Edinburgh study shows – delaying for too long can lead to poorer surgical outcomes and a greater risk of complications.
If you would like to discuss the options for treating hip or knee arthritis, including exploring the best timescale for undergoing joint replacement surgery, contact us.
