Wait-time gains for hip and knee replacement surgery are uneven across Canada, but the Canadian Orthopaedic Association has some fresh ideas

SASKATOON, June 22, 2012 /CNW Telbec/ - "Until medical science comes up with a means of preventing osteoarthritis or minimizing its impact, joint surgery remains the best option for restoring mobility and dexterity," says Dr. Geoff Johnston, president of the Canadian Orthopaedic Association (COA) and a specialist in hand and upper extremity surgery in the Saskatoon Health Region. "So it's truly disheartening to see in the latest report from the Wait Time Alliance that some regions are still struggling to meet benchmarks and, in fact, have seen their wait times lengthen."

Still these provincial averages don't tell the whole story. In Nova Scotia, which received a low grade for hip-replacement surgery and a failing grade for knee-replacement surgery from the Wait Time Alliance, COA past president Dr. Ross Leighton points to a government program that "invested heavily in centralized in-take clinics but failed to consider the need to redistribute resources from other areas to the heavy demand for musculoskeletal health by Nova Scotians, now and for the foreseeable future. If we are ever to shorten our wait times for hip and knee replacement, existing resources must be utilized more strategically. We have enough funds in the system to allow us to meet these benchmarks in all specialties."

And in Ontario, which scored high marks, there is great concern that gains in wait times will be lost because of government austerity measures. By contrast, in Saskatchewan, which received low marks in the WTA report, the Saskatoon Health Region has seen transformative change in how orthopaedic care is delivered. In 2008, after years of committee work and negotiations, virtually all elective joint surgery was consolidated at Saskatoon City Hospital. "The efficiencies gained by the move," says Dr. Johnston, "allowed us to trim our wait times for hip and knee replacement from three years to six months, which is in keeping with WTA benchmarks. We have also invested some new money into innovative programs for delivering anesthesia prior to surgery and pain management afterward. Along with some other cost-saving approaches, we have achieved for little extra cost a fifty-percent increase in annual total-joint surgeries — from 1700 procedures in 2009 to 2500 in 2010 and ever since."

However, there is no one-size-fits-all solution. The complex factors that combine to affect wait times for orthopaedic surgery differ from place to place, and region to region. Through its affiliate, Bone and Joint Canada, the COA has invested time and research resources to develop a process for creating new models of care for delivering orthopaedic surgery. We began with hip and knee replacement surgery because of its complexity and the sheer volume of patients (80,000 surgeries annually). After much effort, we were able to develop a "tool box" of evidence-based best practices that can be used to generate innovation, problem-solving and knowledge transfer throughout the care path. Indeed, in all 10 provinces, a network of administrative and clinical leaders has been applying our approach to hip- and knee-replacement surgery, striving for uniform practice and national standards set by the network itself.

The hip and knee model took four years to develop and implement, but having gone through the development process once, it can now be applied more quickly to other areas of orthopaedics. "Using the same methods, a hip fracture model of care — from start to implementation —  took only 21 months," says Dr. Johnston. "Currently, there are clinical groups who are using our approach to develop models of care for back injuries, and foot and ankle problems. We would like to present our methods and findings to the Council of the Federation's Health Care Innovation Working Group. We believe we have a fresh solution that can be applied to all areas of arthritis care and provide better value for health dollars spent."

Dennis Jeanes, Communications, Canadian Orthopaedic Association
[phone] X6