Health-related quality of life and mobility of patients awaiting elective total hip arthroplasty: a prospective study

TLDR: The length of wait for elective total hip arthroplasty is not associated with postoperative HRQOL and mobility, however, patients who undergo the procedure within 6 months after referral have greater disability at referral, and realize greater gains in HRQol and mobility after surgery, than patients waiting more than 6 months.

Abstract: Background: Waits for elective total hip arthroplasty for osteoarthritis are common in publicly funded health care systems, but they may lead to poorer postoperative outcomes and loss of health-related quality of life (HRQOL) through progressive pain and immobility during the wait These issues have not been examined from the time of referral for surgery Our primary objective was to test whether a longer wait was associated with poorer postoperative HRQOL Methods: Patients needing possible total hip arthroplasty for osteoarthritis were identified upon referral to a surgeon in London, Ont Outcome measures, including the Western Ontario McMaster (WOMAC) Osteoarthritis Index and mobility in the 6-Minute Walk, were assessed at baseline and every 3–6 months thereafter until at least 3 months after the surgery Results: Of 553 potentially eligible patients referred for surgical assessment, 123 were placed on a waiting list for total hip arthroplasty; 114 underwent the procedure, and 99 of them returned for postoperative assessment No significant differences in HRQOL or mobility were seen postoperatively between patients with short waits and those with long waits (a priori definitions ≤ 6 months and > 6 months respectively) At referral, however, patients with short waits had poorer HRQOL and were less mobile than those with long waits ( p = 0002 for WOMAC Osteoarthritis Index total score, 0001 for pain, 0009 for stiffness and 0008 for function; p = 0006 for 6-Minute Walk results) Patients with short waits experienced larger gains in these measures from the time of referral until the postoperative assessment than did patients with long waits ( p = 0002 for WOMAC Osteoarthritis Index total score, p = 006 for 6-Minute Walk results) For patients with long waits, increases in the WOMAC Osteoarthritis Index total score exceeded 10% and losses in walking distance exceeded 30 m from the time of referral to surgery Interpretation: The length of wait for elective total hip arthroplasty is not associated with postoperative HRQOL and mobility However, patients who undergo the procedure within 6 months after referral have greater disability at referral, and realize greater gains in HRQOL and mobility after surgery, than patients waiting more than 6 months Clinically important losses in HRQOL and mobility occur in patients waiting more than 6 months