Significant deterioration in quality of life and increased frailty in patients waiting more than six months for total hip or knee arthroplasty

Abstract

Aims The primary aim of this study was to assess whether patients waiting six months or more for a total hip (THA) or knee (KA) arthroplasty had a deterioration in their health-related quality of life (HRQoL). Secondary aims were to assess changes in frailty and the number of patients living in a state considered to be worse than death (WTD), and factors associated with changes in HRQoL and frailty. Methods This cross-sectional study included 326 patients, 150 males (46.0%) and 176 females (54.0%), with a mean age of 68.6 years (SD 9.8) who were randomly selected from waiting lists at four centres and had been waiting for six months or more (median 13 months, interquartile range 10 to 21) for a primary THA (n = 161) or KA (n = 165). The EuroQol five-dimension questionnaire (EQ-5D) and visual analogue scores (EQ-VAS), Rockwood Clinical Frailty Scale (CFS), and 36-Item Short Form Survey subjective change in HRQoL were assessed at the time and recalled for six months earlier. A state that was WTD was defined as an EQ-5D of less than zero. Results There were significant deteriorations in the EQ-5D (mean 0.175, 95% confidence interval (CI) 0.145 to 0.204; p < 0.001), EQ-VAS (mean 8.6, 95% CI 7.0 to 10.4; < 0.001), and CFS (from 3 “managing well” to 4 “vulnerable”; p < 0.001), and a significant increase in the number of those in a state that was WTD (n = 48; p < 0.001) during the previous six months for the whole cohort. A total of 110 patients (33.7%) stated that their health was much worse and 107 (32.8%) felt it was somewhat worse compared with six months previously. A significantly greater EQ-5D (-0.14, 95% CI 0.08 to 0.28; p = 0.038) and a state that was not WTD (-0.14, 95% CI 0.01 to 0.26; p = 0.031) were associated with a deterioration in the EQ-5D. THA (0.21, 95% CI 0.07 to 0.34; p = 0.002) or a lower (better) CFS (0.14, 95% CI 0.07 to 0.20; p < 0.001) were independently significantly associated with a deterioration in the CFS. Conclusion Patients waiting more than six months for THA or KA had a significant deterioration in their HRQoL and increased frailty, with two-thirds of patients feeling that their health had worsened. Cite this article: Bone Joint J 2022;104-B(11):1215–1224.

Oxford hip and knee scores deteriorate in patients awaiting lower limb arthroplasty during the COVID-19 pandemic and predict a health state ‘worse than death’

“…It should also be noted that our use of the EQ-5D-5L, which differs from contemporary studies that have used EQ-5D-3L scores, 2,3,15,22 does have implications. The EQ-5D-5L descriptive set was developed to provide more precise measurements than the EQ-5D-3L at individual and group levels, 23 and comparative studies have suggested that it has stronger validity for patients awaiting THA and TKA.…”

“… 14 Likewise, cross-sectional studies of patients awaiting lower limb arthroplasty at various orthopaedic departments across the UK have revealed a similar trend, where individuals awaiting THA are significantly more likely to be in a health state WTD. 2 , 15 It was also found that each additional six months of waiting for lower limb arthroplasty corresponds with a clinically significant deterioration in EQ-5D-3L score.…”

“…19 This finding is even more consequential when taking into account the evidence, which has remained consistent before and during the COVID-19 era, that joint-specific functional scores and quality of life deteriorate when patients spend more than six months on the waiting list for surgery. 15,20,21 A study by Scott et al, 3 undertaken prior to the pandemic, indicated that up to one-fifth of patients awaiting THA and TKA were already in a health state WTD. Nationwide data have shown that the number of patients WTD has almost doubled with the cessation of elective activity during the peak of the pandemic.…”

“… 19 This finding is even more consequential when taking into account the evidence, which has remained consistent before and during the COVID-19 era, that joint-specific functional scores and quality of life deteriorate when patients spend more than six months on the waiting list for surgery. 15 , 20 , 21 …”

Hip & Pelvis

“…This is becoming normal for some patients in the UK, and this research group from Edinburgh (UK) have added to some of the previous work carried out in the region, which demonstrated that waiting for arthroplasty surgery can lead to a physical state that was worse than death, and have demonstrated some of the effects that waiting for arthroplasty surgery can have on a patient's general health. 2 A randomly selected group of 326 patients from multiple hospitals were included in the study who had been waiting for six months or more for surgery. These patients were sent questionnaires, the results of which were compared to results that had been obtained six months earlier.…”