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Rheumatology 2002; 41: 390-394
© 2002 British Society for Rheumatology

Original Papers

Who should have priority for a knee joint replacement?

G. M. Woolhead, J. L. Donovan1, J. A. Chard and P. A. Dieppe

Medical Research Council Health Services Research Collaboration and
1 Department of Social Medicine, Canynge Hall, University of Bristol, Bristol BS8 2PR, UK

Objectives. To explore patients' views on who should have priority for total knee replacement (TKR).

Methods. In-depth, semistructured interviews were conducted with 25 patients on the waiting list for a TKR.

Results. All participants were willing to comment on waiting lists and prioritization for TKR. Two major themes emerged: what they thought should happen, and what they thought did happen. They thought that priority should be based on length and degree of suffering, pain severity, immobility, paid employment, payment of National Insurance contributions, and caring for dependants. In contrast, they thought that what actually happened depended on age and weight, excessive complaining and access to private practice.

Conclusions. The participants agreed with health professionals that pain and disability should be key criteria on which to prioritize people for a TKR. However, they also argued for a fair decision-making process that also included additional factors specific to the patient's circumstances. Criteria to aid prioritization for joint surgery need to accommodate the views of patients as well as professionals.

KEY WORDS: Osteoarthritis, Priorities, Total knee replacement, Qualitative research.

Correspondence to: G. M. Woolhead.


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