Factors and Consequences of Waiting Times for Total Hip Arthroplasty

Background Various priority criteria for waiting lists for THA have been proposed. These criteria, however, are not typically included in clinical practice, resulting in unclear management procedures. Further, the clinical effects of waiting times on subsequent pain control or function are unclear.

Questions/purposes Therefore, we asked (1) what factors affect the waiting time for THA when no prioritization criteria are implemented, and (2) does waiting time influence pain and function after THA?

Patient and Methods We prospectively identified all 1495 patients on a waiting list for THA during a year. Of these patients, 991 fulfilled the inclusion criteria, and waiting times were available for 695, of whom 527 (76%) responded to a followup questionnaire. Variables included wait time, sociodemographic data, comorbidities, and WOMAC and SF-36 questionnaires, collected preoperatively and 6 months after surgery.

Results The mean wait time was 5 months (SD, 3.0). Patients with lower levels of pain and better function on the WOMAC scale, or better physical function on the SF-36, had longer waiting times. The gains in function were smaller for patients who waited more than 6 months. The likelihood of perceiving a gain greater than the minimal clinically important difference was greater for patients waiting less than 3 months.

Conclusion Only pain and previous function were significant determinants of prioritizing patients on the waiting list. Suboptimal patient selection had clinical consequences in function gain that affect the quality of the clinical care.

Level of Evidence Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.