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, 50 (2), 101-9

The Wait for Total Hip Replacement in Patients With Osteoarthritis

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The Wait for Total Hip Replacement in Patients With Osteoarthritis

Marie-Claire Gaudet et al. Can J Surg.

Abstract

Objectives: We documented the following components of waiting time for total hip replacement (THR): first surgical consultation, date of decision to operate and date of surgery. We then explored whether these intervals differed by age, sex, occupation or quality-of-life score.

Methods: We used a cross-sectional design and collected the primary data from patients 2 to 4 weeks before they underwent THR. Trained interviewers administered the Medical Outcomes Study Short Form-36 and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which included data on event dates, conservative treatment, demographic information and quality of life. We illustrated waiting times, quality of life and past use of conservative treatment (i.e., cane, exercise, physiotherapy) with descriptive statistics (mean [standard deviation] or median [intraquartile range]) for continuous variables and with percentages for categorical variables. We plotted KaplanMeier graphs for each waiting time component and employed log-rank analysis to determine whether any of these delays differed by age, sex, occupation or disability. We also performed a Cox regression to adjust for all covariates simultaneously.

Results: The median wait from surgical consultation to decision to operate was 0 months. There was no difference between age, sex or occupation. The median wait from decision to operate to the date of surgery was 6 months and did not differ by age, sex or occupation. However, subjects with more severe symptoms (WOMAC) underwent surgery earlier than did those with less severe disease.

Conclusion: Although neither of the waiting time components were associated with age, sex or occupation, patients with more severe symptoms appear to be prioritized for surgery.

Figures

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FIG. 1. Comparison of the date patients reported deciding to have total hip replacement (X axis) and the true date of decision to operate from the medical chart. Data are from the 2 institutions where most (86.3%) of the participants had surgery.
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FIG. 2. Kaplan–Meier curves depicting time-to-event over 5 years from surgical consultation to decision to operate for subgroups divided according to sex, age and occupation.
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FIG. 3. Subjects were grouped by actual wait from surgical consultation to date of surgery (i.e., 28 subjects waited < 3 mo from consultation to surgery). Within each group, subjects were categorized according to what they consider a reasonable wait. Reasonable wait categories were similar across groups.
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FIG. 4. Kaplan–Meier curves depicting time-to-event over 2 years, from the decision to operate to the date of surgery. Subgroups divided according to sex, age and occupation, as well as Western Ontario and McMaster Osteoarthritis Index Physical Function subscale score.

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