Frequently Asked Questions

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  1. How does Alberta's new model of care for hip and knee replacements differ from past practice?

    There are key differences, including:

    • All aspects of care are based on the best evidence available worldwide.
    • There is central intake through single-purpose Hip and Knee Clinics where patients are seen by a multidisciplinary team of health care professionals.
    • The shared-care approach used in a multidisciplinary environment puts patients at the centre of their care.
    • Patient services are fully integrated and each patient's care is coordinated by a Case Manager.
    • Patients are given a customized plan describing what they must do to be at their optimal readiness for surgery.
    • The right care is provided to the right individuals for the right reasons in the right way by the right provider in the right setting at the right time.
    • Patients are empowered and accountable through agreements that stipulate their responsibilities and those of their care team.
    • The skills and knowledge of Alberta's health professionals are used to maximal value.
  2. Is Alberta's new model of care for hip and knee replacement patients being used across the province?

    The model of care is being rolled out as Hip and Knee Clinics - the hub of the model - are established in different areas of the province. The Hip and Knee Clinics serve as central intake for a consultation with an orthopaedic surgeon and assessment by a multidisciplinary team of care providers. They also provide directly or coordinate all care and services, other than family doctor and in-hospital care.

    Alberta's ground-breaking model of care for hip and knee replacement is currently being applied in Edmonton, Calgary, Red Deer, Camrose and Grande Prairie where there are Hip and Knee Clinics serving a large catchment area.

  3. What will I experience if I receive my hip or knee replacement under the new model?

    Here are key steps along the care path under the new model:

    • Patient begins medical journey with visit to family physician.
    • Family physician refers patient to Hip and Knee Clinic.
    • Multidisciplinary team in clinic determines, in consultation with patient, the best treatment plan, such as physiotherapy, medication, surgery, lifestyle change or a combination of these.
    • If surgery is not needed, multidisciplinary team develops a customized treatment plan and sends copy of plan to patient's family physician.
    • If surgery is needed, a Case Manager is assigned to patient. Case Manager assembles require care team - physicians, nurses, therapists and educators - to deliver individualized care leading up to surgery and continuing through rehabilitation.
    • Patient and care team enter into agreement specifying what each party must do to achieve optimal results from surgery. Example: patient commits to stop smoking and commence monitored exercise program to increase strength prior to surgery. Care Team commits to coaching patient toward goals, to surgery date and home care aid.
    • Consultation, surgery, therapy, education, follow-up scheduled to meet or exceed provincial standards.
    • Care Team works as unit through entire patient journey to share case information and deliver optimal care.
    • Case results entered into central database to track and report on performance against provincial standards.
  4. The role of the Hip and Knee Clinics seem to be pivotal. Can you provide more details about these clinics?

    The clinics remove complexity, confusion and inconvenience from the hip and knee patient’s experience. 

    All care, other than family physician and in-hospital surgery and recovery, is provided in or through the clinic and is coordinated by a case manager in the clinic.  This means patients have a one-stop shop instead of being shuffled from one health service provider to another and from one facility to another. 

    The clinics have a multidisciplinary team of health care providers, including orthopaedic specialists, case managers, nurses, physiotherapists, educators, dieticians and nutritionists.  Patients are assessed by an orthopaedic specialist and other health care professionals who determine the course of action that will produce the best outcome.  This may be surgery.  Alternatively, it could be physiotherapy, weight loss, or lifestyle change, or a combination of these. 

    Patients who do not need surgery are referred back to their family physician with a customized treatment plan.

    Patients who need surgery are assigned a Case Manager who assembles the required team of health care professionals and other resources.  The Case Manager prepares a contract that captures the goals, commitments and responsibilities of care providers, the patient and the patient’s family.  The Case Manager monitors progress against goals and commitments in the contract and coordinates the patient’s care ensuring it meets provincial standards.

    Patients also attend a one-hour clinic workshop in which an educator explains the surgical procedure and provides advice on how to prepare for surgery, what to expect in the days following surgery, and how to manage at home during recovery. 

  5. How do I get into a Hip and Knee Clinic in Alberta?
    You must have a referral to a Hip and Knee Clinic from your family doctor.  Your family doctor will submit to the clinic a standardized referral form.  The network of Hip and Knee Clinics in Alberta is expanding as the province’s ground-breaking model of care for hip and knee replacements is rolled out across Alberta.  There are several hip and knee clinics in Alberta, including two in Calgary and one in each of Edmonton, Red Deer, Camrose and Grande Prairie.
  6. How do I find out where I am on the waiting list for a hip or knee replacement?
    If your surgery is being managed through a Hip and Knee Clinic, your Case Manager at the clinic will be able to find your position on the waiting list.  If your surgery is not being managed through a Hip and Knee Clinic, you should contact your surgeon’s office.   
  7. How do I contact my surgeon?
    If your surgery is being managed through a Hip and Knee Clinic, your Case Manager at the clinic may be able to provide the information you need from your surgeon or will contact the surgeon on your behalf.  If your surgery is not being managed through a Hip and Knee Clinic, you should call your surgeon’s office directly.
  8. What does ABJHI do?
    Our work involves searching out the latest medical evidence, designing and evaluating new and innovative ways to deliver bone and joint health care service, benchmarking care against world leaders, project management and support for implementing change. We also support provincial clinical and basic science research projects to improve standards of care and advance knowledge of bone and joint conditions and treatments. 
  9. Can ABJHI help me to get a consultation with a surgeon?
    ABJHI does not provide services of any type, including scheduling consultations, to patients. A consultation with a surgeon must be requested by your family doctor. This can be done by referral to a Hip and Knee Clinic.
  10. Can ABJHI help me with my hip or knee replacement?
    ABJHI does not provide services directly to patients. Contact your Case Manager in the Hip and Knee Clinic or your surgeon if you did not go through a clinic.
  11. Can ABJHI get me into surgery faster?
    ABJHI does not schedule surgery and does not manage wait lists for surgery.
  12. Can ABJHI help me with my hip or knee problems?
    ABJHI does not provide services directly to patients. Contact your family doctor or your Case Manager if you have already been referred to a Hip and Knee Clinic.
  13. How does ABJHI decide what to work on?

    ABJHI establishes its priorities by working collaboratively with others in the health care field, including orthopaedic surgeons, Alberta Health Services, Alberta’s universities, and Alberta Health & Wellness, and by listening to what Albertans are saying about their bone and joint health care.  This approach ensures we always have a finger on the pulse of Albertans’ bone and joint health care needs and helps identify where our efforts can produce maximal benefit for patients, health care providers and taxpayers who fund our public health care system.  

    Our work involves searching out the latest medical evidence, designing and evaluating new and innovative ways to deliver bone and joint health care service, benchmarking care against world leaders, project management and support for implementing change. We also support provincial clinical and basic science research projects to improve standards of care and advance knowledge of bone and joint conditions and treatments. 

    The criteria for selecting a specific area of work include the opportunity to improve patient care and outcomes, need and demand, and potential public economic benefit. 

  14. How does ABJHI collect the patient information it needs to benchmark care, and what does it do with the information?

    ABJHI has agreements with individual orthopaedic surgeons and Alberta Health Services to analyze patient information from their electronic systems.

    All of the patient information we collect is subject to Alberta's Health Information Act and Privacy Act, which means we cannot disclose any information to a third party. All of the information we share with our partners is stripped of any patient identification and aggregated to ensure it remains absolutely private. Furthermore, any research-related work is subject to review by a Research Ethics Board to ensure the dignity, rights, integrity and well-being of participants will be protected, they will be treated fairly, and their free and informed consent will be given prior to the start of the research.

  15. Who is ABJHI accountable to?
    ABJHI’s mission is to be the leading agent for continuous improvement in bone and joint health and health care for Albertans.  ABJHI is accountable primarily to Albertans as it carries out its mission, and to those who fund its work. Our accountability is facilitated through our board of directors, which is composed largely of non-medical members of the public from across the province.  We also work closely with physicians, Alberta Health Services, Alberta’s universities, and the Alberta government to advance the best evidenced-based care for patients.
  16. Who funds ABJHI?
    ABJHI’s funding comes from philanthropy, grants from foundations and programs, and service contracts. 
  17. ABJHI puts a great deal of emphasis on evidence-based health care. How do I determine whether the care treatment proposed by my care provider is evidence-based?

    Ask your health care provider about the evidence for the treatment being proposed.  But keep in mind that differences among patients mean medical professionals, in addition to considering the evidence, must make judgments about when will and will not work for each patient. Their judgment, together with the evidence, is essential to producing good outcomes.

    It is important, therefore, to ask not only about the evidence for the treatment being proposed but also about the medical judgments being made in choosing the treatment path. 

  18. Where does ABJHI find the evidence it uses to determine the best care?

    ABJHI searches the world for the best and latest evidence and conducts evidence reviews, which are published on our web site. We also help generate new evidence by supporting provincial clinical and basic science research projects and by evaluating new approaches to bone and joint health care in Alberta.

    Other reliable sources of health information include the web sites of the Canadian Arthritis Society, the American Arthritis Society, the Canadian Institutes of Health Research, the Canadian Institute for Health Information, and the U.S. National Institutes of Health.

  19. My hip joints need to be replaced. Can I get both hip joints replaced at the same time?

    It is possible to have both hip joints replaced at the same time.  Whether you should do this, however, depends on your particular circumstances and physical and medical conditions. 

    Having both hips replaced at the same time could significantly reduce your mobility after surgery.  Since early mobility – getting up and moving around as soon as possible after surgery – is known to be highly beneficial, a significant delay or reduction can have negative consequences.  In addition, a double-hip replacement will mean a longer recovery period and you will require more support while recovering at home.

    Your options should be discussed with the team of health care providers assigned to your case.  In determining whether the ‘both-at-once’ approach is best, your health care team will take into account your medical and physical conditions, and will want to know about your day-to-day living circumstances and the reasons you would like to have both hips replaced at the same time.  They will work with you to develop a plan that is suited to your individual circumstances and needs.

  20. My knee joints need to be replaced. Can I get both knees replaced at the same time?

    It is possible to have both knees replaced at the same time but a double-knee replacement is rarely done in Alberta.  Whether you should do this depends on your particular circumstances and physical and medical conditions. 

    Having both knees replaced at the same time will significantly reduce your mobility after surgery.  Since early mobility – getting up and moving around as soon as possible after surgery – is know to be highly beneficial, a significant delay or reduction can have negative consequences.  In addition, a double-knee replacement will mean a longer recovery period and you will require significantly more support while recovering at home. 

    Your options should be discussed with the team of health care providers assigned to your case.  In determining whether the ‘both-at-once’ approach is best, your health care team will take into account your medical and physical conditions, and will want to know about your day-to-day living circumstances and the reasons you would like to have both knees replaced at the same time.  They will work with you to develop a plan that is suited to your individual circumstances and needs.

  21. How can I send questions or comments to ABJHI?

    By email to info@albertaboneandjoint.com, or write to us at:

    Alberta Bone and Joint Health Institute
    400, 3280 Hospital Drive NW
    Calgary, AB T2N 4Z6
  22. Who was involved in the Alberta Hip and Knee Replacement Pilot Project?

    The project was administered by the Provincial Arthroplasty Working Committee, which included members from all the participating organizations:

    • Alberta Bone and Joint Health Institute
    • Alberta Orthopaedic Society
    • Orthopaedic surgeons
    • Alberta Health and Wellness
    • Three former regional health authorities:  Calgary, David Thompson, and Capital
    • Alberta Medical Association

    The pilot involved:

    • Three cities: Edmonton, Calgary and Red Deer.
    • 13 orthopaedic surgeons.
    • One Hip and Knee Replacement Clinic in each city.
  23. What types of hip replacement surgery are available?

    There are two types of hip replacement surgery: total hip joint replacement and hip resurfacing.

    Total hip replacement:

    Involves removing the entire head of the femur (thigh bone), a portion of the femur neck and the surface layer of the hip socket in the pelvic bone.  

    The head and neck of the femur are replaced with a ball and stem. This stem fits into the shaft of the femur as an anchor.  The socket is resurfaced.

    The most commonly used device is metal on plastic, which consists of a metal stem, ball and socket, and a polyethylene liner placed inside the socket.  Combinations of ceramic and metal are also used.  The stem for these prostheses is sometimes cemented into the shaft of the femur.

    Hip resurfacing:

    A more recently developed technique that is designed to conserve bone because only the disease-damaged surfaces of the femur and the socket are removed. These surfaces are reshaped and capped with metal implants, which together form a metal-on-metal surface in the hip. This procedure is known as metal-on-metal resurfacing.

  24. What types of knee replacement surgery are available?

    There are two types of knee replacement surgery: total knee replacement and partial knee replacement.

    Total knee replacement:

    Involves replacing the end of the femur (thigh bone) and the end of the tibia (lower leg bone) with metal and plastic components.  If the rear surface of the patella (kneecap) is also damaged, it will be removed and replaced with a polyethylene button.

    Partial knee replacement:

    Also called unicompartmental knee replacement, this is an option when damage from arthritis is limited to only one side of the knee.