Is longer waiting time for total knee replacement associated with health outcomes and medication costs? Randomized clinical trial.
BACKGROUND
The aim of this prospective randomized study was to evaluate the effect of waiting time (WT) on health-related quality of life (HRQoL), knee pain and physical function, and the use and costs of medication of patients awaiting total knee replacement.


METHODS
When placed on the waiting list, 438 patients were randomized into a short waiting time (SWT ≤ 3 months) or a nonfixed waiting time (NFWT > 3 months) group. HRQoL was measured by the 15D, and pain and physical function by modified Knee Society Clinical Rating System at baseline, admission, and 3 and 12 months postoperatively. The costs of medication due to osteoarthritis were calculated at the same measurement points. All analyses were performed using the intention-to-treat principle.


RESULTS
The mean WT was 94 and 239 days in the SWT and NFWT groups, respectively. Apart from higher weekly cost of medication in the SWT group at admission and better HRQoL in the NFWT group 1 year postoperatively, there were no statistically significant differences between the groups in other outcomes during the follow-up.


CONCLUSIONS
Those in the SWT group had higher weekly costs of medication at admission, and reached better HRQoL 3 months earlier than those in the NFWT group, but the latter had better HRQoL after operation. Otherwise, the length of WT was not associated with different health and HRQoL outcomes in the groups.
Tuominen
Ulla
U
Research Department, National Social Insurance Institution of Finland, Helsinki, Finland. ulla.tuominen@thl.fi
Sintonen
Harri
H
Hirvonen
Johanna
J
Seitsalo
Seppo
S
Paavolainen
Pekka
P
Lehto
Matti
M
Hietaniemi
Kalevi
K
Blom
Marja
M
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000191:economics; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D013997:Time Factors; D014850:Waiting Lists
D000894:Anti-Inflammatory Agents, Non-Steroidal