Original Articles
Change in pain and function while waiting for major joint arthroplasty*,**

https://doi.org/10.1054/arth.2001.21455Get rights and content

Abstract

The objective of this study was to examine the change in pain and physical function that occurs while waiting for major arthroplasty. Data were collected prospectively from a cohort of 313 patients who were waiting >1 month for total hip arthroplasty or total knee arthroplasty. The WOMAC and the SF-36 health status instruments were administered at the time the patient was placed on the waiting list and again just before surgery. Minimal amounts of change in pain and physical and psychosocial function occurred for hip and knee arthroplasty patients while they waited. Overall, waiting time did not appear to have a negative impact on the amount of pain and dysfunction experienced.

Section snippets

Patient selection and data collection

The Capital Health Region (CHR), 1 of 17 health regions in the province of Alberta, is located in the northern part of the province and encompasses the city of Edmonton. Each health region is managed by a single health board that oversees acute care and community health programs. Within the CHR, major surgeries such as THA and TKA are performed at only 2 of the 5 acute care facilities [3]. In 1995, 24 orthopaedic surgeons in the region performed TKAs and THAs, with 19 of these surgeons

Patient accrual

During the study period, 965 patients residing within the urban areas of the CHR were placed on the waiting list for major joint arthroplasty. A total of 257 patients were excluded from the study because they were late entries onto the computerized waiting list, and a baseline measure could not be obtained within 1 month of the actual waiting list placement date. Recruitment attempts were made on the remaining 708 patients. Seventeen patients did not speak English, and 121 patients refused

Patient characteristics

The average age of the study subjects was 68.1 years (range, 27-89 years). Of the study sample, 59% were women, and 64% of patients were married. Of patients, 80% reported English or French as their first language. Regarding education level, 41% of patients did not complete high school, 21% completed high school, and 38% had some postsecondary education. At the time of the study, 9% of patients were working full time.

The breakdown of patients according to their primary diagnosis was 96%

Discussion

Preliminary analyses of the data, published previously, indicated that differences in waiting time were not related to pain and function [18]. No biases in waiting occurred with regard to age, gender, marital status, language spoken, education, or work status [19]. Multivariate analyses found that the size of the surgeon's major joint arthroplasty practice was the only significant determinant of waiting time. Persons seen by surgeons who performed <25 major joint arthroplasties per year waited

Conclusion

Patients in this study were enduring a great deal of pain and functional disability when they were placed on the waiting list for major joint arthroplasty; however, the amount of change in pain and function that occurred while waiting for surgery was minimal. Overall, waiting time did not appear to have a negative impact on the amount of pain and dysfunction experienced. Consequently, suffering was merely prolonged. Although symptoms in some patients worsened during this waiting time, it was

Acknowledgements

The authors thank Dr. L. Redfern, for methodologic input; G. Kramer, for data retrieval and linkage; A. Jones and S. Barrett, for assistance with data collection; and C. Kendall, for data entry.

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    *

    Funds were received from the Capital Health Authority Orthopaedic Trust Fund and the Alberta Heritage Foundation for Medical Research in support of the research material described in this article.

    **

    Reprint requests: K. D. Kelly, PhD, Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, PO Box 6500, Shepparton, VIC 3632, Australia. E-mail: [email protected]

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