The burden of wait for knee replacement surgery: effects on pain, function and health-related quality of life at the time of surgery

Abstract

Objective. To examine the change in pain and function related to the knee scheduled for surgery, change in health-related quality of life (HRQoL) and change in contralateral knee pain during pre-surgery wait up until time of surgery. Methods. One hundred and fifty-three patients scheduled for knee replacement were recruited from three hospitals in Québec City, Canada, and followed until surgery. Pre-surgery wait, defined as the time between enrolment on the pre-surgery wait list and surgery, was considered in five categories (⩽3, >3–6, >6–9, >9–12 and >12 months). Pain and functional limitations were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and HRQoL was measured with the medical outcomes study 36-item short form health survey. Results. Mean pre-surgery wait time was 183 (s.d. 121.9) days. Subjects having waited >9–12 months showed significant deterioration of the WOMAC pain (−9.9; 95% CI −19.2, −0.54) and function (−11.1; 95% CI −18.7, −3.4) scores. On the HRQoL SF-36 physical functioning scale, a significant deterioration was seen in subjects having waited >9–12 months (−11.3; 95% CI −18.4, −4.2) and >12 months (−7.1; 95% CI −12.9, −1.3). On the contralateral knee WOMAC pain score, a significant deterioration was observed in subjects having waited >6–9 months (−10.4; 95% CI −16.9, −3.9) and >12 months (−10.7; 95% CI −19.7, −1.7). Conclusion. Pre-surgery wait time has a negative significant impact on pain, function and HRQoL at the time of surgery. The magnitude of deterioration seen in this study may be clinically important. The effects of this pre-surgery deterioration on post-surgery outcomes need to be investigated.