Multicentre Prospective Observational Audit · Patient-Reported Experience

‘Waiting poorly’ for hip and knee arthroplasty

Unmet needs and lack of support while waiting for surgery: findings of the multicentre WAIT-DATA study

C J McCann, N D Clement, C Gee, J Clarke, P Walmsley, N E Ohly, D Deehan, D F Kader, C Stevenson, A J Hall, WAIT-DATA Collaborative

Bone Jt Open 2026;7(9):1215–1225 · doi:10.1302/2633-1462.79.BJO-2026-0132.R1

851

Patients Recruited

UK Hospitals

410d

Median Wait (IQR 212–659)

68.4

Mean Age, yrs (SD 9.9)

As Published 'Waiting poorly' for hip and knee arthroplasty, as published in Bone & Joint Open, Volume 7, Issue 9, September 2026

British Editorial Society of Bone & Joint Surgery

This multicentre audit was published in Bone & Joint Open, a fully open access companion journal to The Bone & Joint Journal. The article is freely available to read and download in full; the open access fee was funded by the University of St Andrews Library Open Access Fund (INSTOA-325).

Journal Bone Jt Open

Study Type Observational Audit

Licence CC BY-NC-ND 4.0

Access Open Access

Read on boneandjoint.org.uk Read on PMC

Abstract

Aims

In socialized health systems, prolonged waiting times for hip and knee arthroplasty lead to progressive decline in patients' health-related quality of life. This multicentre study aimed to evaluate patients' experience of the information, advice, and support received during the waiting period, and to identify which groups feel least supported.

Methods

This study was a multicentre prospective observational audit including 851 patients undergoing elective hip or knee arthroplasty across 14 hospitals in the UK. Participants completed a standardized questionnaire assessing satisfaction with nine domains of preoperative information and support, each rated on a five-point Likert scale. Composite scores for information and advice and support were generated, and associations with demographic, clinical, and psychosocial variables were examined using multivariable linear regression.

Results

Overall satisfaction was moderate. Patients were generally well informed about their condition (mean 4.14 (SD 0.92)) and operation (mean 4.34 (SD 0.88)), but less satisfied with support for weight management (mean 3.49 (SD 0.98)), general health (mean 3.54 (SD 1.01)), and mental wellbeing (mean 3.46 (SD 1.02), p < 0.001). Older age, obesity, socioeconomic deprivation, and new physical or mental health diagnoses were associated with lower satisfaction, though most effects were small. Larger effects were seen between self-reported deterioration in health and quality of life and dissatisfaction with waiting time. Almost half of the patients reported opioid use, and most described worsening function and activity while waiting.

Conclusion

Patients awaiting hip or knee arthroplasty experience substantial physical and psychological decline, compounded by limited holistic support. While procedural information is generally adequate, guidance on lifestyle, wellbeing, and self-management is lacking. The waiting period should be reframed as an active phase of care, with coordinated, multidisciplinary input and clearer responsibility among care providers to ensure patients receive appropriate support.

View paper (Open Access)

Results · Information, Advice & Support

Patients felt informed about surgery — but not supported to live with it

Composite satisfaction with information and advice (mean 4.12, SD 0.81) was significantly higher than composite satisfaction with ongoing support (mean 3.50, SD 0.92); mean difference 0.62 (95% CI 0.57–0.67), p < 0.001. A repeated-measures analysis of variance confirmed significant variation in satisfaction across all nine domains (F(4,3928) = 259.1, p < 0.001).

Informational domains Ongoing support domains Length of waiting time

Hover or tap a bar for exact mean and SD. Error bars omitted for clarity — see Figure 1 in the paper for standard deviations.

Results · Independent Predictors (Multivariable)

Age, deprivation, and new diagnoses independently predicted lower satisfaction

Multivariable linear regression identified independent predictors of perceived support, information/advice, and wait-time satisfaction, adjusting for the same 11 candidate predictors in each model. Effect sizes were generally small. Full results are reported in the paper, Tables III–V.

Support composite score

Predictor	B	95% CI	p
Age (per year)	−0.007	−0.014 to −0.001	0.034
Obese (BMI ≥ 30) vs non-obese	−0.159	−0.288 to −0.029	0.016
SIMD quintile	−0.048	−0.093 to −0.004	0.033
Quality-of-life change	0.105	0.011 to 0.200	0.030
Sex (male vs female)	0.143	0.016 to 0.271	0.028
New physical diagnosis	−0.182	−0.342 to −0.022	0.026
Opioid use	0.143	0.016 to 0.270	0.027

Information & advice composite score

Predictor	B	95% CI	p
Age (per year)	−0.010	−0.015 to −0.004	0.001
Wait time (per year)	−0.096	−0.159 to −0.034	0.003
SIMD quintile	−0.039	−0.078 to 0.000	0.049
Carer status (yes vs no)	−0.124	−0.236 to −0.011	0.031
New mental health diagnosis	−0.270	−0.521 to −0.020	0.034

Wait-time satisfaction

Predictor	B	95% CI	p
Wait time (per year)	−0.357	−0.455 to −0.259	< 0.001
Self-reported health change	0.351	0.221 to 0.481	< 0.001
Self-reported quality-of-life change	0.273	0.143 to 0.403	< 0.001
New physical diagnosis	−0.329	−0.549 to −0.110	0.003
New mental health diagnosis	−0.405	−0.798 to −0.012	0.043

B, unstandardised regression coefficient (each model adjusted for the same 11 candidate predictors). SIMD, Scottish Index of Multiple Deprivation (1 = most deprived, 5 = least deprived).

Results · Health, Function & Opioid Use While Waiting

Substantial physical and psychological decline during the wait

19.3%

New physical health diagnosis while waiting (164/851)

4.9%

New mental health diagnosis while waiting (42/851)

45.0%

Used opioid analgesia while waiting (383/851); 12.7% strong opioids

1.85 / 5

Self-reported health change (SD 0.74); 1.89 for quality of life (SD 0.87)

−1.60

Mean activity level change (SD 1.46), time of listing to preop

Strengths & Limitations

Reading the findings in context

Strengths: the WAIT-DATA audit was large, multicentric, and representative, capturing patient voices across a diverse range of NHS hospitals. The composite satisfaction measures used were internally consistent (Cronbach's α 0.88 for information/advice, 0.93 for support), and the measures used to assess change in health, function, and quality of life demonstrated convergent validity against established instruments (EQ-5D-5L and the Rockwood Clinical Frailty Scale) in a prospective validation study of the WAIT-DATA Health Assessment Tool.

Only 14 of all eligible UK arthroplasty-providing centres contributed data

This represents a relatively small proportion of eligible sites. The cohort also excluded patients who remained on the waiting list, were cancelled, dropped out, or sought private care, which may underestimate the true burden of waiting-related deterioration and introduce selection bias.

Satisfaction was measured with pragmatic, study-specific audit tools

The self-reported metrics used to assess satisfaction were developed with patient and public involvement for the WAIT-DATA project and were not derived from previously validated instruments, which may limit comparability with other studies.

Deterioration and questionnaire responses were retrospectively self-reported at admission

This introduces potential recall bias. However, data capture at the point of admission is common in large-scale service evaluations and offers a universal timepoint for consistent measurement across sites.

The cross-sectional design precludes inference of causation

Although appropriate for describing patient experience across many sites, the design cannot establish causal relationships, and the effect sizes of most associations were small, indicating that patient perceptions are influenced by a complex interplay of factors not captured in this dataset.

Take-Home Messages

Prolonged waiting times for hip and knee arthroplasty are associated with worsening physical and psychological health.

Patients report adequate procedural information but limited ongoing support for managing their condition during the waiting period, reflecting gaps in continuity of care.

Preoperative optimisation and community-based support are feasible and variably delivered, but wider and more consistent implementation requires coordinated, multidisciplinary care with clear responsibility for delivery.

Delivering this level of care is likely to require additional resources and system-level investment.