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


CONCLUSIONS
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.
Desmeules
François
F
Population Health Research Unit, Research Centre of the Laval University Affiliated Hospital, Québec, Canada. francois.desmeules@uresp.ulaval.ca
Dionne
Clermont E
CE
Belzile
Etienne
E
Bourbonnais
Renée
R
Frémont
Pierre
P
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology* / Q000706:statistics & numerical data; D002170:Canada; D018450:Disease Progression; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D013997:Time Factors; D014850:Waiting Lists