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.

The New Zealand health score was developed by the New Zealand government to ensure that patients with the greatest needs were given priority. It allows explicit rationing of health care by clinical priority rather than waiting time (the current UK system). The scoring system has not been validated against an accepted measure of health status and the aim of this study was to compare the New Zealand score with the SF-36.

Patients on the orthopaedic waiting list for hip or knee replacement were sent postal questionnaires to collect demographic data and complete an SF-36 and New Zealand score.

581 patients were sent questionnaires. The response rate was 72% and data was available on 243 knee replacement and 168 hip replacement patients. For patients awaiting hip replacement there was good correlation between the NZ and all health domains of the SF-36 (correlation coefficient: 0.19 – 0.62). In contrast, there was poor correlation between the NZ score and the SF-36 for patients awaiting knee replacement with only physical function having a significant correlation (coefficient 0.25). Breakdown of the NZ score into pain and function components did not improve the correlation with SF-36 scores for these patients.

The New Zealand clinical priority scoring system correlates well with health status, as measured by the SF-36, for patients with hip arthritis awaiting hip replacement. However, the NZ score does not correlate with the SF-36 for patients awaiting knee replacement. This system is now being used by some centres in the UK for waiting list management but has been introduced without comparison to any well-established measures of health status. Its use for the prioritisation of patients who require knee replacement should be questioned.