Worse than death scores rise during pandemic

Almost twice as many orthopaedic patients awaiting surgery have a quality of life ranked ‘worse than death’ during the Covid-19 pandemic compared with pre-pandemic levels, research suggests.

Hip and knee surgery

One third of patients awaiting a hip replacement and more than a fifth of those awaiting a knee replacement are now thought to be in this state, with a significant drop in quality of life seen for every six months they wait for surgery.

The UK-wide findings highlight the suffering experienced by bone and joint patients on waiting lists and the swift action required to help them, surgeons say.

Waiting list backlog

The majority of non-emergency orthopaedic surgery was delayed as a result of the pandemic, leading to a waiting list backlog.

Researchers led by the University of Edinburgh assessed patients on these waiting lists using EuroQol-five dimensions (EQ-5D), a quality of life survey that includes questions on mobility, pain, and the ability to participate in daily life.

The research team looked at 843 patient ratings from 10 centres in the UK and compared these to scores gathered in Edinburgh from 2014 to 2017 from more than 4000 patients.

Quality of life

EQ-5D is scored from -0.6 to 1 where 1 is full health and 0 is considered death. Therefore negative scores are read as ‘worse than death’, based on the UK general public stating that they could not bear to survive in this health state.

The scores can be used by doctors and healthcare services to make decisions on resource allocation.

In the current study, 35 per cent of patients waiting for a hip replacement and 22 per cent of patients waiting for a knee replacement rated their scores below zero and so were deemed to be in a state worse than death.

This was an increase from the previous figures which showed negative scores for 19 per cent of those waiting for total hip operations and 12 per cent of those waiting for total knee operations.


Health related quality of life also deteriorated by a significant amount for each additional 6 months on the waiting list, the research suggests.

The study is published open access in The Bone and Joint Journal.

These patients are suffering. Because of the pandemic, elective surgery such as hip and knee replacements has all but stopped. Orthopaedic patients have been disproportionately affected by cancellations of surgery during the pandemic as we have been allowed to do the least amount of operating compared to normal levels of all surgical specialties. This study shows how severe living with arthritis is. We know that joint replacements can be life changing and, in our view, these operations are not ‘elective’ and our patients should not be at the bottom of the pile as we restart surgery.

Ms Chloe ScottConsultant Hip and Knee Surgeon, and Honorary Senior Clinical Lecturer at the University of Edinburgh


At the start of the first lockdown I had already been on the waiting list for an orthopaedic outpatient appointment for over four months. On my daily permitted walk during the first lockdown I was limping valiantly but by Autumn I was struggling with stabbing pain and decreasing flexibility – even getting in and out of a car was agonising. I feared that my normally active lifestyle could be lost forever. Less than three weeks after the operation I threw away my stick and am now I am walking distances I could only dream of before the operation – and without pain. I have my life back.

A hip patient who had urgent surgery in January 2021Anonymous

Related links

Original research

Edinburgh Medical School