A meta-analysis of 89,996 patients awaiting a hip or knee replacement shows a steady decline in joint function, with the decline becoming clinically important after around 6 months of waiting. The point, therefore, is to confirm the indication and to avoid a pointless wait when surgery is genuinely needed.
If hip pain, knee pain or a loss of function is making you consider an operation, Noria Health Hub can arrange a full check-up or a second medical opinion in Brussels, with a report within 24 h, coordinate your care where needed across more than 40 medical pathways in 48 h, then, if your medical condition allows, arrange surgery within 7 days.
While you wait, function and quality of life decline
| What was followed | The result |
|---|---|
| 89,996 patients, 26 studies of which 16 in meta-analysis, 2024 | Functional deterioration of 0.0575% per day of waiting. The authors place the threshold of clinically significant deterioration at around 6 months |
| 356 joints followed between the 6th and 12th month of waiting, 2024 | Quality of life down 0.071 points at the hip and 0.069 at the knee on the EQ-5D scale, significance reached in both |
| 326 patients already waiting more than 6 months, median wait 13 months, 2022 | A 0.175 point fall in quality of life over 6 months. 33.7% report much worse health, and 48 patients move into a state the scale rates below zero |
| 843 patients compared with 4,241 controls, 2021 | 35% of those awaiting a hip and 22.3% awaiting a knee are in a state rated below zero, against 18.9% and 12.1% before the crisis period. A loss of 0.0135 points per month of waiting |
| 217 patients at 12 months awaiting a knee replacement, 2025 | 77.9% have developed chronic pain. Use of weak opioids is multiplied by 3.63, strong opioids by 11.8 |
On the EQ-5D scale, a value below zero corresponds, technically, to a health state that respondents rate as worse than death. That is the definition of the scale, not a formula added by the authors.
After surgery, the effect of the delay is far less clear
In the same meta-analysis of 89,996 patients, the relationship between waiting time and quality of life after the operation is not significant, p = 0.715. Waiting damages the patient’s life before the procedure. That it permanently caps the final result is not established with the same solidity.
Two limitations matter here. First, postoperative results vary enormously from one study to another: heterogeneity reaches 99.7%, which makes an overall average hard to apply to an individual patient. Second, a 2022 study shows that a more degraded state before the operation can go with a larger postoperative gain. The data therefore do not allow anyone to state that a long wait definitively ruins the final result.
Finally, none of these data come from a randomised trial, and none ever will, because you do not draw lots for a patient’s waiting time. All these cohorts are observational and exposed to indication bias.
How long people actually wait
| Country / region | What is measured | The wait |
|---|---|---|
| Canada | From family doctor to treatment, orthopaedic surgery | 57.5 weeks median wait in 2024 |
| Europe | Hip replacement, 2024 median | 209 days in Hungary; 343 in Poland; 667 in Slovenia |
| Australia | Scheduled ENT surgery, septoplasty | 320 days median wait in 2024-2025 |
International figures do not measure exactly the same segment of the pathway: some start from referral by the family doctor, others from the moment the patient is added to a surgical list. We therefore present them as markers of access to care, not as directly interchangeable values.
Surgeon volume, a measurable effect but limited to certain complications
Across 37,881 patients, a surgeon’s activity volume is associated with the risk of complication after hip replacement, above and below a threshold of 35 replacements a year.
| What is compared | Low volume | High volume |
|---|---|---|
| Dislocation | 1.9% | 1.3%, a third lower in crude risk and 48% after adjustment |
| Surgical revision | 1.5% | 1.0%, a third lower in crude risk and 44% after adjustment |
| Infection, periprosthetic fracture, thrombosis, death | No significant difference | No significant difference |
The number of patients who need a high-volume surgeon to avoid one dislocation is 172, and 204 to avoid one revision. The effect is real and modest, and it does not cover everything.
This relationship is not universal, however. Across 12,515 hip revisions followed up to 7 years, no difference in risk was found between high and low volume centres, and a 2025 systematic review concludes there is low confidence in the evidence for a volume-outcome relationship in knee revision. What holds for a first replacement does not extend mechanically to revision.
Implants: how long they last, and how satisfied patients really are
The English national registry follows more than 1.5 million hip replacements and 1.66 million knee replacements. The knee revision rate is 3.11% at 10 years and 4.20% at 15 years, against a reference threshold set at 5% at 10 years. The implants hold.
The most quoted figure in the field, one patient in five dissatisfied after a knee replacement, deserves careful handling. A review of 208 studies and 95,560 patients finds median satisfaction of 88.9%, with a range running from 65% to 100% across series, and only 13% of those studies used a validated measurement instrument. A 2022 review arrives at a mean dissatisfaction rate of 10%, and 7.3% once complications are excluded. Publishing “one in five” without mentioning that challenge would be a shortcut.
A second opinion mainly clarifies the decision
Across 141 patients assessed in a structured second-opinion programme before knee replacement, immediate surgery was confirmed in 40% of cases, postponed conditional on worsening in 40%, and advised against in 20%. The clearest effect is not on the indication, it is on the decision, with the share of undecided patients falling from 41% to 12%.
At the shoulder, timing matters, but only for certain lesions. Across 871 patients, early rotator cuff repair is associated with fewer retears, 9.9% against 15.9%. A finer study shows this benefit is clear for traumatic tears, 2.6% against 16.7%, and not significant for degenerative tears. Generalising “operate early” to all shoulder pathology would be wrong.
What the studies do not allow us to claim
We will not write that waiting ruins the result of a joint replacement, because the reference meta-analysis does not show it. Nothing entitles us to claim that a second opinion avoids one operation in five in the general population, because these programmes only recruit patients who already had doubts. And we will never present the correlation between waiting and deterioration as demonstrated causation.
What is solid, and it is enough, is that in Canada the median wait reached 57.5 weeks in orthopaedic surgery in 2024, and that in Europe a hip replacement could reach 343 days in Poland and 667 days in Slovenia. Beyond roughly 6 months, studies of patients awaiting a replacement show a clinically important decline in function.
In practice, if this concerns you
You set out your problem, your symptoms or your question. Reports, test results and images already available can be studied before you arrive, so that the pathway is prepared. The aim is not to run every possible test, but to select those that can genuinely help confirm a hypothesis, rule out a risk or guide the decision. The results are then brought together and the next steps organised. Follow-up is coordinated from there.
Need a medical opinion quickly? For a concern that does not call for emergency services, you can ask to speak to a doctor at any time through Noria Health Hub. This on-demand medical consultation is billed separately from the work-up pathway.
Further reading
The companion articles.
Waiting” rel=”noopener” target=”_blank”>https://noriahealth.com/blog/what-delay-really-costs-what-the-studies-say/”>Waiting for a diagnosis or a treatment, what the studies actually measure
Pain” rel=”noopener” target=”_blank”>https://noriahealth.com/blog/pain-that-waits-what-the-literature-measures/”>Pain that waits, what the literature measures
Sources
Clement ND et al., The functional and psychological impact of delayed hip and knee arthroplasty, systematic review and meta-analysis of 89,996 patients, Scientific Reports, 2024. https://doi.org/10.1038/s41598-024-58050-6
Scott CEH et al., Patient health-related quality of life deteriorates significantly while waiting six to 12 months for total hip or knee arthroplasty, The Bone and Joint Journal, 2024. https://doi.org/10.1302/0301-620X.106B2.BJJ-2023-0324.R1
Clement ND et al., Significant deterioration in quality of life and increased frailty in patients waiting more than six months, The Bone and Joint Journal, 2022. https://doi.org/10.1302/0301-620X.104B11.BJJ-2022-0470.R2
Clement ND et al., The number of patients worse than death while waiting for a hip or knee arthroplasty has nearly doubled, The Bone and Joint Journal, 2021. https://doi.org/10.1302/0301-620X.103B.BJJ-2021-0104.R1
Clement ND et al., Chronic knee pain while awaiting arthroplasty, Bone and Joint Open, 2025. https://doi.org/10.1302/2633-1462.63.BJO-2024-0210.R1
Farrow L et al., Prioritisation of patients awaiting hip and knee arthroplasty, Musculoskeletal Care, 2022. https://doi.org/10.1002/msc.1645
Fraser Institute, Waiting Your Turn, Wait Times for Health Care in Canada, 2025. https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2025
Canadian Institute for Health Information, Joint Replacement Wait Times, updated 2026. https://www.cihi.ca/en/indicators/joint-replacement-wait-times
NHS England, Referral to Treatment Waiting Times, Statistical Press Notice, March 2026. https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/
Ravi B et al., Relation between surgeon volume and risk of complications after total hip arthroplasty, BMJ, 2014. https://doi.org/10.1136/bmj.g3284
Vink MC et al., High-volume hospitals do not perform better than low-volume hospitals in septic and aseptic revision total hip arthroplasty, Acta Orthopaedica, 2025. https://doi.org/10.2340/17453674.2025.44331
Matthews et al., Low confidence in the cumulative evidence for a volume-outcome relationship after revision total knee replacement, Knee Surgery Sports Traumatology Arthroscopy, 2025. https://doi.org/10.1002/ksa.12641
National Joint Registry, 21st Annual Report, 2024. https://www.njrcentre.org.uk/national-joint-registry-annual-report-2024/
Kahlenberg CA et al., Patient satisfaction after total knee replacement, a systematic review, HSS Journal, 2018. https://doi.org/10.1007/s11420-018-9614-8
DeFrance M, Scuderi GR, Are 20 percent of patients actually dissatisfied following total knee arthroplasty, The Journal of Arthroplasty, 2022. https://doi.org/10.1016/j.arth.2022.10.011
Weigl M et al., Effects of a medical second opinion programme on patients’ decision for or against knee arthroplasty, BMC Musculoskeletal Disorders, 2021. https://doi.org/10.1186/s12891-021-04465-5
Baur A et al., Early rotator cuff repair yields lower retear rates, systematic review and meta-analysis, Journal of Clinical Medicine, 2025. https://doi.org/10.3390/jcm14155552
Chen Y et al., Functional outcomes of early versus delayed arthroscopic repair for traumatic and degenerative rotator cuff tears, Journal of Clinical Medicine, 2026. https://doi.org/10.3390/jcm15062205
Seddigh S et al., Association between surgical wait time and hospital length of stay in primary total knee and hip arthroplasty, Bone and Joint Open, 2021. https://doi.org/10.1302/2633-1462.28.BJO-2021-0033.R1