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

Rheumatology (Oxford). 2010 May;49(5):945-54. doi: 10.1093/rheumatology/kep469. Epub 2010 Feb 8.


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 (< or =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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Knee / psychology*
  • Arthroplasty, Replacement, Knee / statistics & numerical data
  • Canada
  • Disease Progression
  • Female
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • Knee Joint / surgery
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / physiopathology
  • Osteoarthritis, Knee / psychology*
  • Osteoarthritis, Knee / surgery
  • Pain / psychology*
  • Pain Measurement
  • Prospective Studies
  • Quality of Life / psychology*
  • Severity of Illness Index*
  • Time Factors
  • Waiting Lists