Aims. This study aimed to describe preoperative waiting times for surgery in hip fracture patients in Norway, and analyze factors affecting waiting time and potential negative consequences of prolonged waiting time. Methods. Overall, 37,708 hip fractures in the Norwegian Hip Fracture Register from January 2014 to December 2018 were linked with data in the Norwegian Patient Registry. Hospitals treating hip fractures were characterized according to their hip fracture care. Waiting time (hours from admission to start of surgery), surgery within regular working hours, and surgery on the day of or on the day after admission, i.e. ‘expedited surgery’ were estimated. Results. Mean waiting time was 22.6 hours (SD 20.7); 36,652 patients (97.2%) waited less than three days (< 72 hours), and 27,527 of the patients (73%) were operated within regular working hours (08:00 to 16:00). Expedited surgery was given to 31,675 of patients (84%), and of these, 19,985 (53%) were treated during regular working hours. Patients classified as American Society of Anesthesiologists (ASA) classes 4 and 5 were more likely to have surgery within regular working hours (odds ratio (OR) 1.59; p < 0.001), and less likely to receive expedited surgery than ASA 1 patients (OR 0.29; p < 0.001). Low-volume hospitals treated a larger proportion of patients during regular working hours than high volume hospitals (OR 1.26; p < 0.001). High-volume hospitals had less expedited surgery and significantly longer waiting times than low and intermediate-low volume hospitals. Higher ASA classes and Charlson Comorbidity Index increased waiting time. Patients not receiving expedited surgery had higher 30-day and one-year mortality rates (OR 1.19; p < 0.001) and OR 1.13; p < 0.001), respectively. Conclusion. There is inequality in waiting time for hip fracture treatment in Norway. Variations in waiting time from admission to hip fracture surgery depended on both patient and hospital factors. Not receiving expedited surgery was associated with increased 30-day and one-year mortality rates. Cite this article: Bone Jt Open 2021;2(9):710–720

Aim. Restarting elective services presents a challenge to restore and improve many of the planned patient care pathways which have been suspended during the response to the COVID-19 pandemic. A significant backlog of planned elective work has built up representing a considerable volume of patient need. We aimed to investigate the health status, quality of life, and the impact of delay for patients whose referrals and treatment for symptomatic joint arthritis had been delayed as a result of the response to COVID-19. Methods. We interviewed 111 patients referred to our elective outpatient service and whose first appointments had been cancelled as a result of the response to the COVID-19 pandemic. Results. Patients reported significant impacts on their health status and quality of life. Overall, 79 (71.2%) patients reported a further deterioration in their condition while waiting, with seven (6.3%) evaluating their health status as ‘worse than death’. Conclusions. Waiting lists are clearly not benign and how to prioritize patients, their level of need, and access to assessment and treatment must be more sophisticated than simply relying on the length of time a patient has been waiting. This paper supports the contention that patients awaiting elective joint arthroplasty report significant impacts on their quality of life and health status. This should be given appropriate weight when patients are prioritized for surgery as part of the recovery of services following the COVID-19 pandemic. Elective surgery should not be seen as optional surgery—patients do not see it in this way

Method: We reviewed the hospital notes of 45 patients who underwent a lumbar discectomy over a 30month period. The care pathway was divided into three components: Pre-Hospital Wait (time from GP referral to first outpatient appointment), Hospital Wait (first out-patient appointment to being listed for surgery) and the Waiting List period. The patients were divided into three groups: those following a standard pathway (group I), patients referred with an MRI scan (group II) and emergency admissions to hospital (group III). Results: The groups I, II and III comprised of 18, 12 and 7 patients respectively. The mean Pre-Hospital Wait in weeks was 16 (group I) and 14 (group II). The Hospital Wait was 12 (group I), 3 (group II) and 1 (group III). The Waiting List period was 26 (group I), 18 (group II) and 1 (group III). The difference in The Hospital Wait between groups I and II reached significance. Discussion: The Waiting List Period is often blamed as the causa principale for a delay in treatment. This review shows that a considerable time is spent in the Hospital Wait period and draws attention to a recognised delay in the care pathway, which requires a multidisciplinary approach to reduce its effect

The purpose was to define the economic and health costs of waiting for total hip joint replacement surgery. A prospective cohort of 122 patients requiring primary hip arthroplasty (HA) was recruited from four hospitals in the lower North Island. Health related quality of life (HRQL), using self-completed WOMAC questionnaires, was assessed monthly from enrolment pre-operatively to six months post surgery. Monthly cost diaries were used to record medical, personal and other costs. Data was analysed using PC-SAS to test the strength of associations between costs and waiting times, and changes in HRQL pre- and post-surgery. The mean waiting time was 5.2 months and mean cost of waiting for surgery was $1,376 per person per month (pp pm) with medical, personal and social costs contributing $404, $399, and $573, respectively. Waiting more than 6 months was associated with an increased cost of $730 pp pm for a total cost of $2177 pp pm (p< 0.003). Age was correlated with greater loss of income (< 65 years) (p=0.001) and higher medical costs (< 65 years) (p=0.08). An incremental improvement over time in WOMAC scores post-operatively was identified (p=0.0001). Older age (p=0.01), community services card use (p=0.003) and a greater number of months waiting (p=0.1) were negatively correlated with post-surgical improvement after adjusting for other variables. Longer waits for HA incur greater economic costs and impact on patient recovery. This lends weight to the view that a shorter waiting time for HA significantly reduces costs to individuals and society and improves health outcomes

Introduction and Aims: To define the economic and health costs of waiting for THJR surgery. Method: A prospective cohort of 122 patients requiring primary total hip arthroplasty (HA) was recruited from four hospitals. Health-related quality of life (HRQL) using self-completed WOMAC questionnaires was assessed monthly from enrolment pre-operatively to six months post-surgery. Monthly cost diaries were used to record medical, personal and other costs. Data was analysed using PC-SAS to test the strength of associations between costs and waiting times, and changes in HRQL pre- and post-surgery. Results: The mean waiting time was 5.2 months, and the mean cost of waiting for surgery was NZ$1376 per person per month, with medical, personal, and social costs contributing NZ$404, NZ$399, NZ$573, respectively. Waiting for more than six months was associated with an increased cost of NZ$730 per patient per month for a total cost of NZ$2177 per patient per month. Age was correlated with greater loss of income and higher medical costs. An incremental improvement over time in WOMAC scores post-operatively was identified. Older age, community services card use and a greater number of months waiting were negatively correlated with post-surgical improvement. Conclusion: Longer waits for HA incur greater economic costs and impact on patient recovery. This shows that shorter waiting time for HA significantly reduces costs to individuals and society and improves health outcomes

Objective: Prolonged waiting time after being referred for a specialist opinion has plagued the NHS despite pressures to deliver optimum healthcare. We have assessed changes in clinical situation in patients referred to a spinal service while awaiting the first assessment.

Materials & Results: 89 patients were referred to our unit between Jan 2001 and December 2004. The gender distribution in this cohort was equal and the mean age was 50.7 yrs. The mean delay for being seen in the clinic was 28.4 mo (16–58 mo). Significant changes in the symptom pattern were noted in 46 patients, of which 8 patients reported radicular symptoms on a different side. In addition, 7 patients experienced an increased severity in the existing symptoms. 43 patients had been referred to us with an MRI. However due to the delay, 20 of these patients required re-scanning. Following the clinical assessment 25 patients were referred for Physiotherapy, 4 patients required a further clinical review and 44 patients were referred for further imaging.

Conclusion: The problem of excessive out-patient waiting time results in changes in symptom patterns and an increase in the severity of existing symptoms. The changes frequently results in an increased requirement of re-imaging.

Introduction. Idiopathic scoliosis is a lateral curvature of the spine >10° as measured on a frontal plane radiograph by the Cobb angle. Important variables in assessing the risk of curve progression include a young age at presentation, female sex, a large amount of growth remaining, the rate of growth, the curve magnitude, and the curve location. Curves >20° have an inherently low risk of progression. Surgery is indicated for curves >50° or rapidly progressing curves. The timing of surgery is paramount in order to intervene in cases where rapid progression is evident to prevent further deterioration. There is a greater likelihood for more complex surgery to be required in major curves. At present, there are severe restrictions on resources to cater for patients with scoliosis. As a result, patients spend excessive periods on waiting lists prior to having their procedure. The aim of this study is to analyse the progression of curves of patients while on the waiting list and assess the cost implications of curve deterioration. Methods. A retrospective analysis of 40 cases of adolescent idiopathic scoliosis performed from between 2007-2010 was carried out. All radiographs at the time of being placed on the waiting list and the time of admission were reviewed to assess the Cobb angle. The radiographs were analysed independently by three spinal surgeons to determine what level of surgical intervention they would recommend at each time point. The final procedure performed was also recorded. A cost analysis was carried out of all of the expenses that are incurred as part of scoliosis surgery, including length of hospital stay, intensive care admission, spinal monitoring, implant cost, and the requirement for multiple procedures. Results. The average time on the waiting list was 12 months (range 6 – 16 months). Comparison of radiographs at the time of listing and time of admission revealed a deterioration of the Cobb angle by an average of 12°. The average Cobb angle at time of surgery was 78° (range 55° - 96°). Analysis of cost implications revealed an increase in cost based on implant requirements, length of stay and intensive care admission estimated at 25%. Conclusion. The results of this study demonstrate that there is a significant deterioration of scoliosis curvature in patients while on the waiting list. The consequence of this progression results in longer operative time, increased requirement for intensive care beds, an increase in requirements for additional levels of pedicle instrument, and a prolonged length of stay. The implications of the deterioration in curvature result in an increase in overall cost estimated at 25%. Waiting list initiatives established over the past 6 months have reduced the waiting list to 6-9 months. Further efforts to continue this initiative are likely to give rise to further cost reductions and result in more manageable curvatures being dealt with in a timely fashion

Purpose of study: To assess the effect of 18-month waiting list, on the subsequent requirement of knee arthros-copy.

Materials and methods: Medical records of 310 patients with knee pain, who had been placed on the non-urgent arthroscopy waiting list in 2003, were assessed. Diagnoses and the grade of doctor placing the patients on the list were also noted. The percentages of patients undergoing surgery as planned, as well as of those being cancelled were looked at.

Results: 61% of patients underwent knee arthroscopy as planned. 12% considered their symptoms insignificant as to require operation. 11% wanted a later operation date because of personal reasons, 7% had their surgery privately or had been expedited through the waiting list scheme because of deterioration in their condition but remained on NHS waiting list, and 9% patients had their surgeries postponed because of other medical reasons.

Conclusion: For a group of patients having been placed on an 18-month waiting list for knee arthroscopy, 40% did not subsequently have surgery within the NHS setting, as planned initially.

Aim

To investigate the impact of waiting for surgical treatment for bone and joint infection (BJI) on patient self-reported quality of life (QoL).

Cite this article: Bone Joint Res 2022;11(12):890–892.

Given the prolonged waits for hip arthroplasty seen across the U.K. it is important that we optimise priority systems to account for potential disparities in patient circumstances and impact. We set out to achieve this through a two-stage approach. This included a Delphi-study of patient and surgeon preferences to determine what should be considered when determining patient priority, followed by a Discrete Choice Experiment (DCE) to decide relative weighting of included attributes.

The study was conducted according to the published protocol ([https://boneandjoint.org.uk/article/10.1302/2633-1462.310.BJO-2022-0071](https://boneandjoint.org.uk/article/10.1302/2633-1462.310.BJO-2022-0071)). The Delphi study was performed online over 3 rounds with anonymous ranking and feedback. Included factors were voted as either Consensus in, Consensus out, or No Consensus• following an established scoring criterion. A final consensus meeting determined the prioritisation factors (and their levels) to be included in the DCE. The DCE was then conducted using an online platform, with surgeons performing 18 choice sets regarding which merited greater priority between two hypothetical patients. Results were collated and analysed using multinomial logit regression analysis (MNL).

For the Delphi study there were 43 responses in the first round, with a subsequent 91% participation rate. Final consensus inclusion was achieved for Pain; Mobility/Function; Activities of Daily Living; Inability to Work/Care; Length of Time Waited; Radiological Severity and Mental Wellbeing. 70 individuals subsequently contributed to the DCE, with radiological severity being the most significant factor (Coefficient 2.27 \[SD 0.31\], p<0.001), followed by pain (Coefficient 1.08 \[SD 0.13\], p<0.001) and time waited (Coefficient for 1-month additional wait 0.12 \[SD 0.02\], p<0.001). The calculated trade-off in waiting time for a 1-level change in pain (e.g., moderate to severe pain) was 9.14 months.

These results present a new method of determining comparative priority for those on primary hip arthroplasty waiting lists. Evaluation of potential implementation in clinical practice is now required.

The progressive painful and disabling predicament of patients with severe osteoarthritis awaiting a total hip or knee arthroplasty (THA/TKA) results in a decline in muscle mass, strength and function also known as Sarcopenia.

We conducted a cross-sectional, prospective study of patients on the waiting-list for a THA/TKA in the South Australian public healthcare system and compared the findings to healthy participants and patients newly referred from their general practitioners. Participants with a history of joint replacements, pacemakers and cancers were excluded from this study. Outcomes of this study included (i) sarcopenia screening (SARC-F ≥4); (ii) sarcopenia, defined as low muscle strength (hand grip strength M<27kg; F<16kg), low muscle quality (skeletal muscle index M<27%, F<22.1%) and low physical performance (short physical performance battery ≤8). Additional outcomes include descriptions of the recruitment feasibility, randomisation and suitability of the assessment tools.

29 healthy controls were recruited; following screening, 83% (24/29) met the inclusion criteria and 75% (18/24) were assessed. 42 newly referred patients were recruited; following screening, 67% (30/45) met the inclusion criteria and 63% (19/30) were assessed. 68 waiting list patients were recruited; following recruitment, 24% (16/68) met the inclusion criteria and 75% (12/16) were assessed. Preliminary data shows increasing waiting time is associated with higher SARC-F scores, lower hand grip strength and lower muscle quality.

As a pilot study, preliminary data demonstrate that: (1) study subjects’ willingness to participate will enable a larger study to be conducted to establish the prevalence of sarcopenia and the diagnostic cut-off points for this patient group. (2) SARC-F is a suitable tool to screen for sarcopenia. (3) There is a positive correlation between waiting time for a THA/TKA and sarcopenia.

Purpose/Background

More than 20 million UK citizens have MSK conditions, and post-pandemic the backlog awaiting access to MSK services has increased. The most prevalent MSK condition is low back pain (LBP), and getUBetter has been recommended by NICE as one of five digital health technologies for helping manage LBP. Purpose: Evaluate impact of getUBetter on a community MSK waiting list.

Waitemata DHB serves a population of approximately 500,000. There are 396 general practitioners who refer to the services. Approximately 400 patients are referred per month. Budget constraints mean not all patients referred can be seen and various Ministry of Health guidelines and Health and Disability Commission rulings help to determine which patients will be seen.

All referrals to the service are assessed by one surgeon. There are specific requirements for referral of patients with certain complaints.

Assistance is given to the general practitioner in organising the more specialist investigations. Help is given to GPs by telephone for patient management particularly of the simpler conditions.

Approximately a quarter of patients referred are referred back to the GP. MRI and CT scans are arranged of which half are returned.

Time must be allocated within the department to allow this specialist liaison with GPs to occur.

Adverse local tissue reactions (ALTR), such as so-called pseudotumours associated with metal-metal bearings, can also occur secondary to corrosion products from modular tapers where at least one side is composed of cobalt alloy. In 1988, Svensson et al. reported a fulminant soft-tissue pseudotumour following a cementless, metal-on-polyethylene total hip. This case had all of the features of ALTR that were subsequently observed in association with contemporary large diameter metal-metal bearings, having the same histological characteristics that Willert and colleagues termed ALVAL in 2005.

There is a documented increased risk of femoral taper corrosion in association with larger diameter (>32 mm) metal-metal bearings. There may be a generic increase in the risk of taper corrosion with larger diameter bearings, regardless of acetabular bearing type. Other variables include the design and manufacturing tolerances of the taper and head, the stiffness of the neck, implantation time, and possibly in vivo assembly. Head and neck moment arm and neck length have not been demonstrated to be independent risk factors for taper corrosion or fretting. Retrieval analyses indicate that fretting and corrosion tend to be higher on the head than on the stem. ALTR has similarly been described in association with corrosion of the modular neck-stem junction. Taper corrosion is the probable explanation for elevated ion levels and ALTR in association with well-positioned metal-metal total hip bearings and low bearing wear. Whole blood or serum metal levels are elevated with a greater elevation of cobalt compared to chromium. Ion analyses are now relatively accessible and reliable and should be obtained in the evaluation of a painful total hip without an obvious cause. Cross-sectional imaging, such as a MARS MRI scan, can demonstrate associated changes in the periprosthetic tissues and secure the diagnosis.

Treatment recommendations are similar to those established for hips with metal-metal bearings and ALTR. Removal of the modular cobalt alloy head and/or neck component is recommended. At this time, there are no established criteria for the degree of “acceptable” femoral taper damage. The dilemma faced by the revising surgeon is whether to expose the patient to the potential morbidity associated with revision of a well-fixed femoral stem, particularly a distally-fixed, extensively porous-coated stem, in the setting of mild-to-moderate fretting and corrosion of the femoral taper. Several manufacturers offer ceramic heads with a titanium alloy taper sleeve inside the head specifically for mating to previously used femoral tapers. It is not recommended to put a ceramic head taper directly onto a used femoral taper. Surface damage of the used femoral taper can create high localised stresses in the ceramic head and predispose to head fracture. The same principles can be applied to corrosion of a stem-neck taper. If the modular neck is made of cobalt alloy, it is preferable to exchange it for one made of titanium alloy (if available). Again, there are no established criteria for the degree of “acceptable” femoral taper damage. The paucity of reported experience with such revisions inhibits further comment at this time.

It is prudent to be suspicious of “taperosis” considering that the majority of heads used over the past 5 years are cobalt alloy and >36 mm in diameter, many contemporary stems have narrower, and hence more flexible necks, some tapers are smaller (shorter), more variable in vivo assembly secondary to “minimally invasive” surgical techniques, and the risk of taper corrosion increases with time in situ. Additional studies are needed to determine the incidence of clinically significant taper corrosion. There are more than 30 different head-stem tapers worldwide and the incidence of clinically significant taper corrosion is likely variable for different head-stem combinations. Similar to ALTR that occur with metal-metal bearings, some cases of ALTR secondary to taper corrosion may be asymptomatic.

The primary aim was to assess whether patients waiting 6-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 change in level of frailty and the number living in a state worse than death (WTD).

Eight-six patients waiting for a primary TKA or KA for more than 6-months were selected at random from waiting lists in three centres. Patient demographics, waiting time, EuroQol 5-dimension (EQ-5D) and visual analogue scores (EQ-VAS), Rockwood clinical frailty score (CFS) and SF-36 subjective change in HRQoL were recorded at the time of and for a timepoint 6-months prior to assessment. The study was powered to the EQ-5D (primary measure of HRQoL).

There were 40 male and 46 female patients with a mean age of 68 (33 to 91) years; 65 patients were awaiting a THA and 21 a TKA. The mean waiting time was 372 (226 to 749) days. The EQ-5D index deteriorated by 0.222 (95%CI 0.164 to 0.280, p<0.001). The EQ-VAS also deteriorated by 10.8 (95%CI 7.5 to 14.0, p<0.001). CFS progressed from a median of 3 to 4 (p<0.001). The number of patients WTD increased from seven to 22 (p<0.001). Thirty-one(36%) patients felt their HRQoL was much worse and 28 (33%) felt it was somewhat worse.

Patients waiting more than 6-months had a clinically significant deterioration in their HRQoL and demonstrated increasing level of frailty with more than a quarter living in a health state WTD.

Aim: To analyse the Dunedin residual orthopaedic waiting list based on a simple patient questionnaire and a quality of life assessment using EuroQol and SF12.

Method: All patients on the residual waiting list were sent a postal questionnaire enquiring about their need for surgery and their quality of life. Based on their answers, patients were entered into three action groups: 1. back to GP care 2. clinical review 3. booked for surgery. Those patients requiring a clinical review were seen in a special clinic and reassessed in relation to their need for surgery.

Results: Two hundred and sixty-one patients were surveyed. One hundred and fifty-eight had complete data available for analysis and of the remaining 103 patients, 88 were taken off the waiting list for various reasons. Fifteen did not reply. The average time on the waiting list was 19 months (range: < six months to eight years). Sixty percent of the patients felt that their condition had changed and 99% felt that they still required the surgery. The results of the EuroQol and DF12 questionnaire revealed three groups of patients. 1. normal (9 patients). 2. slight impairment (115 patients) 3. moderate impairment (34 patients). Most of these patients had stable conditions except the sub group with deteriorating osteoarthritis of the hip/knee. Group 1 patients were all referred back to their GP. Thirty percent of group 2 patients were referred back to their GP, 60% were booked for a review and 10% were booked for surgery. None of Group 3 patients were referred back to their GP. Seventy percent required a clinical review and 30% were booked for surgery. Our clinical review is continuing but it is anticipated that those who still require surgery and score above the financial threshold will probably be less than one third of the cases.

Conclusion: This paper describes a decision making rationale in relation to assessment of continuing need for surgery in patients on the residual orthopaedic waiting list. Eighty percent of patients had stable conditions, which were not interfering significantly with their activities of daily living and could be managed safely by the GP. Further work is required to identify those patients who are at risk of deteriorating and to work out a practical and cost effective monitoring programme.

Our aim was to assess the impact of the increasing number of patients on orthopaedic waiting lists on general practitioners in New Zealand.

A 10-point questionnaire was developed in association with the General Practice Department at the Wellington School of Medicine, and mailed to 250 randomly chosen general practitioners around New Zealand. One hundred and fifty general practitioners returned the survey.

Sixty three per cent of general practitioners reported having between eleven and thirty patients on an orthopaedic waiting list in their practice. 85% of general practitioners reported spending up to an extra 6 hours per month looking after problems caused by having to provide extra care for the patients. In 90% of cases general practitioners reported that their patients required considerably greater community support in the form of extra physiotherapy, meals-on-wheels and occupational therapy. In 138 cases, general practitioners reported greater levels of stress in the families of patients on waiting lists. The majority of general practitioners reported an increased need for analgesia and night sedation during the period on a waiting list. They also reported substantial increases in paperwork necessary to access social supports.

This study documents the burden on general practitioners produced by the increasing waiting lists, and the re-alignment of waiting lists. This burden is reducing the general practitioner’s ability to deal with routine general practice problems, and likely adversely affects the health of other New Zealanders. There is a need for a study of patients on waiting lists to further assess their needs.

Funding for the health service is limited and this inevitably leads to rationing. However, the allocation of funding to different specialities and clinical areas often has no rational basis. The aim of this study was to evaluate the health status of patients on the orthopaedic waiting list.

The SF-36 was used as a postal questionnaire and sent to all adult patients on the elective orthopaedic waiting list at our hospital. Demographic data was collected and patients were grouped by intended operation. The health domains of the SF-36 were adjusted for demographic variables and compared to population norms using non-parametric statistical methods.

The SF-36 was sent to 1586 patients and 1155 responded (73%). Analysis was undertaken for hip replacement (n=194), knee replacement (n=291), knee arthroscopy (n=232), foot and ankle (n=147) and cruciate ligament reconstruction (n=46). All diagnostic groups had significantly worse (p< 0.05) scores for all domains of health when compared to population norms. Patients awaiting joint replacement had worse disability (p< 0.001) than other groups, particularly for pain and physical function. Patients over 40 years awaiting arthroscopy had disability approaching these levels and those awaiting ACL reconstruction had poor physical function. In general, patients awaiting foot or ankle surgery had better health than other diagnostic groups but still had significant reductions when compared to normal. Health scores were not related to the Townsend index for social deprivation, indicating equity of access within the health service.

Patients awaiting hip and knee replacement have worse health than others on the waiting list. The SF-36 could be a useful tool if priority on waiting lists were to be determined by pain and disability rather than waiting time.

Introduction: Long waits for total hip joint replacement (THJR) surgery affect quality of life and are likely to impose significant medical, personal and other costs on individuals and society.

Aim: To define the economic and health costs of waiting for THJR surgery.

Method: A prospective study of 130 patients requiring primary THJR is being undertaken. Data on health related quality of life (HRQL), using self completed EQ-5D and WOMAC questionnaires, are collected on enrolment, and every month before surgery and continuing for six months after surgery. Monthly cost diaries are used to record medical, personal and other costs. Inferential statistics and regression analyses will be used to test the strength of associations between costs and waiting times, and changes in HRQL before and after surgery.

Results: Preliminary results indicate that costs are greatest before surgery (mean=$70.41 per person, per month), remain high during the first month after surgery (mean=$53.24 pp pm), and drop significantly (p< 0.05) within six months after surgery (mean=$12 pp pm). WOMAC scores of pain, stiffness and physical function show significant improvements (p< 0.05) within three months after surgery. The EQ-5D also indicated significant (p< 0.05) positive changes.

Conclusions: The preliminary results suggested that patients had high dependency levels for the first month after surgery. Consequently, costs associated with recuperation after surgery may have shifted from the public hospitals onto the community and family. Significant improvements in HRQL by three months after surgery indicated that THJR is a successful intervention for osteoarthritis.