Pensioner & Surgeon Discussing Knee Surgery

A recent study highlighted just how grave the consequences of delayed hip and knee replacements can be for patient quality of life. Jim Newman looks at the real-world impact of long waiting lists.

Many years ago when I was a junior doctor, it wasn’t uncommon to see patients waiting two years for a knee replacement. A lot could happen in those two years.

There’s a critical point at which osteoarthritis tips from being a painful but just about manageable condition to one where mobility deteriorates massively. When it does, the impact of osteoarthritis on every other aspect of a patient’s life becomes even more pronounced. The quality of sleep worsens. The ability to exercise practically disappears, increasing the risk of weight gain, which is far from ideal for a prospective knee surgery patient. Mental health suffers. Even the outcome of the knee replacement procedure, once the patient reaches the top of the waiting list, is less assured because the lack of exercise has resulted in a loss of muscle mass around the knee. That’s not an easy thing to reverse in older patients.

Small wonder that so many patients arrived for their knee replacement in a wheelchair.

> Discover more about partial or total knee replacements
> Discover more about osteoarthritis, symptoms & treatments

A deteriorating picture

For a long time, two year waiting lists for joint replacement surgery were nothing more than a memory. But it won’t have escaped your notice that, in the wake of the pandemic, waiting lists have increased significantly. Every week the NHS has to divert resources to supporting Covid or flu patients is another list of elective patients whose operations are put back, impacting everybody in the queue and those about to join it.

The Daily Mail reports 1 in 8 people waiting for such a procedure. That’s 7.19 million. Locally, at my own NHS Trust (Mid Yorks), the wait for treatment is 18 weeks. At other trusts the wait is considerably longer. And these figures are, of course, averages. So for every patient who gets a hip or knee replacement as part of emergency surgery following, for example, a fall or a road traffic accident, there’s another who waits much longer than 18 weeks. Currently, 400,000+ patients nationally have been on the list for longer than a year.

The impact of a six month wait for a knee replacement

This study of 326 patients with an average age of 68 found patients waiting more than six months for a total hip or knee replacement experienced a significant deterioration in their health-related quality of life (HRQoL) and increased frailty. Two-thirds of patients felt that their health had worsened.

Conversely, and somewhat astonishingly, we know that the improvement in quality of life scores for joint replacement patients once they have had their operation is better even than for cancer care. I make that point not to suggest that there’s anything wrong with the focus on cancer, but to demonstrate just how incredibly transformative a joint replacement can be.

> Questions about your knee surgery?
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More patients paying for private treatment

It will come as no surprise to anyone that as waiting lists have increased, so the numbers of patients paying for private knee surgery has increased too. According to this report in the BMJ, the number of self-funded knee replacements increased by 153% between the second quarters of 2019 and 2022.

The waiting times for private knee surgery are 4-6 weeks.

But as long as we maintain our current approach to healthcare, this isn’t sustainable. Not everyone who needs a knee replacement can afford the private route, yet there’s a real risk currently that many people on an NHS waiting list will wait longer than six months. Unless we can reduce that wait, we’ll see worse outcomes of the NHS knee replacements we do perform, and much reduced quality of life for everyone forced to endure lengthy waits.

The challenge to reduce waiting lists

It’s important to stress that, if private knee surgery isn’t an option for you, you will reach the top of the NHS waiting list in time and for many that time is within 18 weeks. As surgeons—and across the NHS—we are doing all we can to reduce those wait times, but there are barriers over which we have no control, not least a chronic lack of nursing staff.

As the evidence shows, it’s vital that we put that right, and soon.

> Find out more about Jim Newman
> Questions about your knee surgery?
> Discover more about partial or total knee replacements