In the queue for total joint replacement: patients' perspectives on waiting times. Ontario Hip and Knee Replacement Project Team

J Eval Clin Pract. 1998 Feb;4(1):63-74. doi: 10.1046/j.1365-2753.1998.t01-1-00006.x.


We assessed patients on the waiting lists of a purposive sample of orthopaedic surgeons in Ontario, Canada, to determine patients' attitudes towards time waiting for hip or knee replacement. We focused on 148 patients who did not have a definite operative date, obtaining complete information on 124 (84%). Symptom severity was assessed with the Western Ontario/McMaster Osteoarthritis Index and a disease-specific standard gamble was used to elicit patients' overall utility for their arthritic state. Next, in a trade-off task, patients considered a hypothetical choice between a 1-month wait for a surgeon who could provide a 2% risk of post-operative mortality, or a 6-month wait for joint replacement with a 1% risk of post-operative mortality. Waiting times were then shifted systematically until the patient abandoned his/her initial choice, generating a conditional maximal acceptable wait time. Patients were divided in their attitudes, with 57% initially choosing a 6-month wait with a 1% mortality risk. The overall distribution of conditional maximum acceptable wait time scores ranged from 1 to 26 months, with a median of 7 months. Utility values were independently but weakly associated with patients' tolerance of waiting times (adjusted R-square = 0.059, P = 0.004). After splitting the sample along the median into subgroups with a relatively 'low' and 'high' tolerance for waiting, the subgroup with the apparently lower tolerance for waiting reported lower utility scores (z = 2.951; P = 0.004) and shorter times since their surgeon first advised them of the need for surgery (z = 3.014; P = 0.003). These results suggest that, in the establishment and monitoring of a queue management system for quality-of-life-enhancing surgery, patients' own perceptions of their overall symptomatic burden and ability to tolerate delayed relief should be considered along with information derived from clinical judgements and pre-weighted health status instruments.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip / mortality
  • Arthroplasty, Replacement, Hip / psychology*
  • Arthroplasty, Replacement, Knee / mortality
  • Arthroplasty, Replacement, Knee / psychology*
  • Attitude to Health*
  • Data Collection
  • Female
  • Humans
  • Male
  • Middle Aged
  • Ontario
  • Osteoarthritis / surgery*
  • Pain Measurement
  • Patient Satisfaction / statistics & numerical data*
  • Patient Selection*
  • Risk Assessment
  • Severity of Illness Index
  • Time Factors
  • Waiting Lists*