Delayed Hip and Knee Arthroplasty: The Functional and Psychological Impacts
Total hip and knee replacements are among the most common elective orthopedic procedures worldwide, primarily performed to alleviate pain and restore function in patients with end-stage osteoarthritis. However, prolonged waiting times for these surgeries have become a significant concern, especially in the aftermath of the COVID-19 pandemic, which led to a substantial reduction in elective surgeries and extended waiting lists. A comprehensive systematic review and meta-analysis published in Scientific Reports sheds light on the functional and psychological impacts of delayed hip and knee arthroplasty, analyzing data from 89,996 patients across 26 studies.
Understanding the Scope of the Issue
In the United Kingdom, the lifetime risk of undergoing a total hip replacement (THR) or total knee replacement (TKR) at the age of fifty is significant, with 11.6% for THR and 10.8% for TKR in females, and 7.1% and 8.1% respectively in males. In the United States, over half of the patients diagnosed with symptomatic knee osteoarthritis are expected to undergo TKR. These statistics underscore the prevalence of these procedures and the potential impact of delays on a large patient population.
Preoperative Deterioration Due to Delays
The meta-analysis revealed a significant association between increased presurgical waiting times and deteriorations in joint-specific function and health-related quality of life (HRQOL). Specifically, for each additional day of waiting, there was an absolute deterioration of 0.0575% in joint function and 0.05% in HRQOL. This suggests that clinically meaningful declines in these outcomes could occur within six months of waiting for surgery. Such deterioration not only exacerbates patients’ physical discomfort but also impacts their overall well-being and daily functioning.
Psychological Impact and Patient Perspectives
Beyond the physical implications, the psychological toll of prolonged waiting times is profound. Patients expressed unanimous dissatisfaction with delays, reporting increased anxiety, frustration, and a sense of neglect. The anticipation of surgery, coupled with escalating pain and disability, can lead to heightened stress and diminished mental health. This psychological burden underscores the necessity for timely surgical interventions and adequate support mechanisms for patients awaiting surgery.
Postoperative Outcomes and Waiting Times
Interestingly, while preoperative deterioration due to delays is evident, the meta-analysis did not find a significant relationship between waiting times and postoperative outcomes. Patients generally experienced substantial improvements in joint function and HRQOL following surgery, regardless of the length of the presurgical waiting period. However, it’s important to note that prolonged preoperative deterioration could potentially influence long-term recovery trajectories, and further research is warranted to explore this aspect comprehensively.
Global Trends and Healthcare Implications
The issue of extended waiting times is not confined to the UK. Similar trends have been observed in countries like Canada, the Netherlands, and Denmark, indicating a global challenge in managing elective orthopedic surgeries. The COVID-19 pandemic has exacerbated these challenges, leading to a backlog of cases and increased strain on healthcare systems worldwide. Addressing this issue requires a multifaceted approach, including optimizing surgical schedules, increasing resource allocation, and implementing policies to reduce waiting times.
Recommendations for Healthcare Policy and Practice
To mitigate the adverse effects of delayed hip and knee arthroplasty, immediate action is essential. Healthcare systems should prioritize reducing waiting times through strategic planning and resource management. This may involve increasing surgical capacity, streamlining preoperative assessments, and enhancing patient education and support during the waiting period. Additionally, implementing measures to monitor and address the psychological well-being of patients awaiting surgery can help alleviate anxiety and improve overall patient satisfaction.
Conclusion
The systematic review and meta-analysis highlight the significant functional and psychological impacts of delayed hip and knee arthroplasty. Prolonged waiting times are associated with deteriorations in joint function and HRQOL, as well as increased psychological distress among patients. While postoperative outcomes remain positive, the preoperative decline emphasizes the need for timely surgical interventions. Healthcare systems must take proactive steps to reduce waiting times and support patients during the preoperative period to enhance overall outcomes and patient well-being. While this meta-analysis is looking at European health systems where patients generally do have longer wait times for procedures when compared to the United States, this doesn’t stop patients in the US from delaying their care for a multitude of reasons causing the same detrimental effects.
If you enjoyed this article, consider reading our post on How Mental Health Can Impact Joint Replacement Outcomes.
