• Ki Wai Ho, Gerald Pong, Wai Chin Poon, Kwong Yin Chung, Yan-Yan Kwok, and Kwok Hing Chiu.
• Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong.
• J Eval Clin Pract. 2021 Feb 1; 27 (1): 69-74.

BackgroundTotal knee arthroplasty (TKA) remains the surgical gold standard treatment for patients suffering from end-stage osteoarthritis (OA) of the knee. However, due to the high demand and scarce medical resources, the waiting time for surgery is astoundingly lengthy. Controversies are shown in numerous studies, on whether physical functionality and mental status decline or remain stable over the waiting period. This study aims to evaluate the progression in patients suffering from end-stage OA while on the waiting list for TKA.MethodsOne hundred and twenty-seven patients suffering from end-stage OA who were on the TKA waiting list were prospectively recruited from our orthopaedics specialist clinic. They were assessed once a year for 2 years or until surgery. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC), SF-36 self-rated questionnaire and 15D health-related quality of life (HRQoL) questionnaire were used as outcome measurements for functionality and disability assessment.ResultsPatients on the waiting list for TKA showed a progressive increase in pain and disability level within the first year (P = .035). Those patients waiting for more than 2 years showed worsening HRQoL (P < .05) as time progressed. However, no significant difference was observed between the first and second years.ConclusionsA decline in functionality and increase in disability were shown in follow-up assessments conducted every year. However, a plateau effect is observed with end-stage disease. This emphasizes that more active conservative management programmes should be introduced and implemented while patients are enlisted on the TKA waiting list. Moreover, timely surgical intervention can improve patients' overall function.Trial RegistrationThis study involved human participants and reports health-related outcomes concerning the HRQoL in patients with end-stage OA of the knee. Thus, it was registered, retrospectively, as a clinical trial under the U.S. National Library of Medicine ClinicalTrials.gov (https://clinicaltrials.gov/) on March 4, 2018.© 2020 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.

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