Background Long waiting times for certain medical, diagnostic and surgical procedures are the result of high demand for relatively scarce resources. Most western countries have established queues for elective procedures and consultations. Among elective surgical procedures, total hip and knee replacements have the longest waiting lists, twice as long as waits for elective cardiovascular and eye surgery. The data on waiting lists are not highly reliable, nevertheless it is clear that in British Columbia the wait for hip and knee arthroplasty grew from 2 months 1995 to 6 months in 1999 and that a similar increase took place in Ontario. At Vancouver Hospital the median wait for these procedures over the past year has been 7-8 months. Patients are not usually considered candidates for hip or knee replacement until pain and dysfunction have become severe. But waiting prolongs dysfunction and pain that already warrant surgery. A number of studies have demonstrated the burden of suffering that could be relieved by short waits. The question of whether and how much prompt access to surgery could benefit our patients over the long term has attracted very little research. A study we are proposing will for the first time directly address the short- and long-term benefit of expedited surgery with patient-based measures and economic costs, and will do so using valid reliable methods and instruments so that its results can be clearly understood and widely accepted.