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 wait-ing 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 Clini-cal 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 inter- val (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.