Objectives The primary research question is: Does expedited hip and knee replacement result in improved lower-extremity function at 36 months post randomization as measured by the WOMAC functional dimension? A secondary component to the functional question is whether expedited surgery improves pain and stiffness scores as measured by WOMAC and generic quality of life (QOL) as measured by SF-36 and HUI3? Secondary questions are: Does joint-specific and generic QOL deteriorate significantly during waiting? Does prolonged waiting increase the economic cost associated with hip and knee arthroplasty? And does expedited surgery have an effect on patient satisfaction with major joint replacement? Hypothesis Reducing waiting time may improve patient outcomes. This is biologically plausible that prolonging the arthritic process in these joints may result in muscle atrophy, tissue contractures and deterioration of general medical condition that may not be fully recoverable post-surgery. There is some evidence for the harm concurrent with waiting but none for its deleterious long-term effects on hip and knee replacement patients. Our hypothesis is that prolonged waiting is a significant independent risk factor for reduced long-term benefit following surgery. Our secondary hypothesis is that prolonged waiting for hip and knee arthroplasty increases the total economic cost associated with treatment of these disorders.