Developing priority criteria for hip and knee replacement: results from the Western Canada Waiting List Project

The Western Canada Waiting List Project (WCWL), a federally funded partnership of 19 organizations, was created to develop tools for managing waiting lists. The WCWL panel on hip and knee replacement surgery was 1 of 5 panels constituted under this project.

The panel developed and tested a collection of standardized clinical criteria for setting priorities among patients awaiting hip and knee replacement. The criteria were applied to 405 patients in 4 provinces. Regression analysis was used to determine the set of criteria weights that collectively best predicted clinicians' overall urgency ratings. Inter-rater and test-retest reliability was assessed from 6 videotaped patient interviews, scored by orthopedic surgeons, related professionals and general practitioners.

The priority criteria accounted for over two-thirds of the observed variance in overall urgency ratings (adjusted R2 = 0.676). The panel modified the criteria and weights based on the empirical findings and on clinical judgement. The reliability of the priority criteria for the hip and knee replacement tool was among the strongest of the 5 instruments developed in the WCWL project.

The panel considered the criteria easy to use and reasonably reflective of expert surgical judgement regarding clinical urgency for hip and knee replacement. Further development and testing of the tool appears warranted.