The painful truth of waiting for hip and knee arthroplasty in Northern Ireland

Abstract

AimsThe aim of this study was to report health-related quality of life (HRQoL) and joint-specific function in patients waiting for total hip or knee arthroplasty surgery (THA or TKA) in Northern Ireland, compared to published literature and a matched normal population. Secondary aims were to report emergency department (ED) and out-of-hours general practitioner (OOH GP) visits, new prescriptions of strong opioids, and new prescriptions of antidepressants while waiting.MethodsThis was a cohort study of 991 patients on the waiting list for arthroplasty in a single Northern Ireland NHS trust: 497 on the waiting list for ≤ three months; and 494 waiting ≥ three years. Postal surveys included the EuroQol five-dimension five-level questionnaire (EQ-5D-5L), visual analogue scores (EQ-VAS), and Oxford Hip and Knee scores to assess HRQoL and joint-specific function. Electronic records determined prescriptions since addition to the waiting list and patient attendances at OOH GP/EDs.ResultsOverall, 712/991 (71.8%) responded at ≤ three months for THA (n = 164) and TKA (n = 199), and ≥ three years for THA (n = 88) and TKA (n = 261). The median EQ-5D-5L score in those waiting ≤ three months was 0.155 (interquartile range (IQR) -0.118 to 0.375) and 0.189 (IQR -0.130 to 0.377) for ≥ three years. Matched controls had a median EQ-5D-5L 0.837 (IQR 0.728 to 1.000). Compared to matched controls, EQ-5D-5L scores were significantly lower in both waiting cohorts (p < 0.001) with significant differences found in every domain. Negative scores, indicating a state “worse than death”, were present in 40% at ≤ three months and 38% at ≥ three years. Patients waiting ≥ three years had significantly more opioid (28.4% vs 15.2%; p < 0.001) and antidepressant prescriptions (15.2% vs 9.9%; p = 0.034) and significantly more joint-related attendances at unscheduled care (11.7% vs 0% with ≥ one ED attendance (p < 0.001) and (25.5% vs 2.5% ≥ one OOH GP attendance (p < 0.001)).ConclusionPatients on waiting lists in Northern Ireland are severely disabled with the worst HRQoL and functional scores studied. The lack of deterioration in EQ-5D-5L and joint-specific scores between patients waiting ≤ three months and ≥ three years likely reflects floor effects of these scores. Prolonged waits were associated with increased dependence on strong opiates, depression, and attendances at unscheduled care.Cite this article: Bone Joint J 2023;105-B(7):783–794.

Socioeconomic deprivation is associated with worse health-related quality of life and greater opioid analgesia use while waiting for hip and knee arthroplasty

“…4 Some of these patients are waiting up to 5.5 years for surgery. 5 Currently, waiting lists for elective THA and TKA in NI are the worst in the UK, due to a variety of social, political, and economic reasons. 5 Patients waiting a prolonged time for total joint replacement (TJR) experience a significant deterioration in quality of life (QoL), and an increase in frailty while they wait.…”

“…5 Currently, waiting lists for elective THA and TKA in NI are the worst in the UK, due to a variety of social, political, and economic reasons. 5 Patients waiting a prolonged time for total joint replacement (TJR) experience a significant deterioration in quality of life (QoL), and an increase in frailty while they wait. 6,7 The proportion of patients waiting for TJR who were experiencing the worst health-related quality of life (HRQoL) scores (negative scores deemed "worse than death" (WTD)) doubled during the COVID-19 pandemic.…”

“…Patients in the group who had waited three or more years for surgery had a significantly greater opioid use, antidepressant use, and more joint-related attendances at unscheduled care, including emergency department (ED) and out-of-hours general practitioner (OOH-GP) visits. 5 Social deprivation has been defined by the American Psychological Association as "limited access to society's resources due to poverty, discrimination, or other disadvantage. " 9 Social deprivation can negatively impact access to healthcare, including elective orthopaedic procedures.…”

“…4 Some of these patients are waiting up to 5.5 years for surgery. 5 Currently, waiting lists for elective THA and TKA in NI are the worst in the UK, due to a variety of social, political, and economic reasons. 5…”

“…Patients in the group who had waited three or more years for surgery had a significantly greater opioid use, antidepressant use, and more joint-related attendances at unscheduled care, including emergency department (ED) and out-of-hours general practitioner (OOH-GP) visits. 5…”