Click on a question below to see the answer.
- How does the ABJHI decide what to work on?
We establish our priorities by working collaboratively with others in the health care field, including orthopaedic surgeons, regional health authorities, Alberta’s universities, and Alberta Health & Wellness, and by listening to what Albertans are saying about 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 maximum benefit for patients, health care providers and taxpayers who fund our public health care system.
Our work involves conducting clinical studies, searching out and evaluating medical evidence, designing, testing and assessing new and better ways to deliver health care service, and helping to educate the public. The criteria for selecting a specific area of endeavour include the opportunity to improve patient care and outcomes, need and demand, and potential public economic benefit.
- How does the ABJHI collect its patient information, and what does it do with the information?
For time-limited clinical evaluations, such as the Hip & Knee Replacement Pilot program, the Institute receives permission to collect information from the patients themselves through a signed consent form. For ongoing evaluations, the Institute has agreements in place with individual orthopaedic surgeons and Alberta's regional health authorities to collect and 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 any third party that could be used to identify a patient. All of the information we share with our partners is stripped of any patient identification and aggregated across several providers or health regions to ensure that it remains completely private. Furthermore, any research involving human subjects 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.
- Who is the ABJHI accountable to?
The ABJHI’s mission is to be the leading agent for continuous improvement in bone and joint health and health care for Albertans. The ABJHI is accountable primarily to Albertans as it carries out its mission, and to those who fund its work. Our accountability is facilitated through the Institute’s Board, which is composed largely of non-medical members of the public from across the province. We also work closely with physicians, regional health authorities, Alberta’s universities, and the Alberta government to advance the best evidenced-based care for patients.
- Who funds ABJHI?
The majority of the ABJHI’s funding has come from philanthropy and grants from foundations and programs. In June 2007, Alberta Health and Wellness announced a one-time funding of $6.3 million to the Institute to help lead province-wide implementation of a new model for hip and knee replacements. In addition to financial support, some ABJHI staff have been transferred temporarily from other organizations, such as regional health authorities.
- How do I determine if the care I am receiving is evidence-based?
Health care should always be based on a combination of evidence and sound medical judgment because all patients are not the same. Differences among patients mean medical professionals must make judgments about what will and will not work for an individual. Their judgment is key to producing good outcomes. It is important, therefore, that patients ask their health care provider about the evidence for the treatment being proposed and about the medical judgments being made in choosing the treatment path.
As the umbrella organization for bone and joint health care, research and education in Alberta, the ABJHI works continuously to generate evidence and the results are published on our Website. Other reliable sources of health information include the Websites of the Canadian Arthritis Society (http://www.arthritis.ca), the American Arthritis Society (http://www.americanarthritis.org), the Canadian Institutes of Health Research (http://www.cihr-irsc.gc.ca), and the U.S. National Institutes of Health (http://www.nih.gov).
- How do I get access to the right bone and joint health care provider?
The ABJHI is working with bone and joint physicians, other health care professionals and regional health authorities in Alberta to help patients get access to the right care providers. This is being done as each continuum of care is developed. The hip and knee replacement continuum is already being implemented. Continuums of care for back and spine, orthopaedic trauma, and soft tissue of the knee are now being advanced.
Your family physician and other health care providers are informed of how best to access the right provider as each continuum is completed.
- Where does the ABJHI find the evidence it uses to determine the best care?
ABJHI searches the world for the best and latest evidence. We also generate our own evidence through the clinical studies in which we participate and from our evaluation of approaches to health care in Alberta.
- 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 means you will not have to go through surgery on two separate occasions, assuming the outcome is positive. However, recovery can be more difficult and painful and your mobility will be significantly more reduced, which usually means you will require more support while recovering at home.
Your options should be discussed with the team of health care providers who are assigned to your case. In determining whether the ‘both-at-once’ approach is best, your health care provider 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.
- How can I send my comments to the ABJHI about my experience with the health care system?
Patient experience is an important part of the work we do to review and evaluate outcomes in bone and joint health care. The information we gather – including patient experience – is essential to continuously improving bone and joint health and health care for Albertans.
Please tell us about your experience by writing to:
Alberta Bone & Joint Health Institute
400, 3280 Hospital Drive NW
Calgary AB T2N 4N1 CANADA
Or by email to:
info@albertaboneandjoint.com
- What changes are being made now that the Alberta Hip and Knee Replacement pilot project has ended?
The new model for hip and knee replacements is being rolled out as the standard of care in the three health regions that participated in the pilot project – Capital, David Thompson and Calgary, and will soon be rolled out to all remaining health regions in Alberta.
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What can patients expect to experience now that the hip and knee replacement model is being adopted as the standard of care?
The new model will make the patient’s journey through the public health care system more satisfying and successful. Key steps along the way:
Patient begins medical journey with visit to family physician.
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Family physician refers patient to Hip and Knee Replacement Clinic.
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Clinic team determines required treatment such as physiotherapy, medication, surgery, lifestyle change or a combination of these.
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Case manager assigned to patient. Case manager assembles required care team - physicians, nurses, therapists and educators - to deliver individualized care from initial consultation with specialist through to surgery, rehabilitation and, if necessary, lifestyle change.
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Patient and care team enter into contract specifying what each party must do to achieve optimal results. 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.
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Consultation, surgery, therapy, education, follow-up scheduled to meet or exceed provincial standards.
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Care team works as unit through entire patient journey to share case information and deliver optimal results.
- Case results entered into central database to track and report on performance against provincial standards.
- The role of the Hip and Knee Replacement clinics seems 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.
Instead of being shuffled from one health service provider to another and from one facility to another, patients with hip and knee problems have a one-stop shop for all their pre-surgery health care services.
The clinics have a multidisciplinary team of health care providers, including orthopaedic specialists, case managers, nurses, physiotherapists, educators, dieticians and nutritionists. A specialist examines the patient to determine the course of action that will produce the best outcome. In some instances, this may be surgery. In others, it could be physiotherapy, weight loss, or lifestyle change, or a combination of these.
If surgery is required, the patient is assigned a case manager who assembles the required team of health care professionals and other resources, and develops a care path the patient and care providers must follow for a successful outcome. The care path will include a detailed treatment plan with goals, commitments and expected outcomes. It might include measures to optimize patients such as physiotherapy to strengthen muscles, a weight-loss program, including specific targets and timelines, or a stop-smoking program, including medication to reduce nicotine craving. The commitments made by care providers and patients are stipulated in a contract and progress is monitored by the case manager.
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.
- Where are the Hip and Knee Replacement Clinics located?
There is a clinic in each of the three health regions that participated in the pilot to test the new hip and knee replacement model. The network of clinics will be expanded as the model is rolled out across the province.
In Calgary Health Region:
Gulf Canada Square
401 9th Avenue SW
Calgary, AB T2P 3C5
Tel: (403) 266-3471
Fax: (403) 221-4387
In David Thompson Health Region:
306, 3939 50A Avenue
Red Deer, AB T4N 4E6
Tel: (403) 358-5950
Fax: (403) 358-5808
In Capital Health Region:
College Plaza
1608, 8215 112 Street NW
Edmonton, AB T6G 2C8
Tel: (780) 433-3155
Fax: (780) 432-6395
- 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:
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Alberta Bone & Joint Health Institute
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Alberta Medical Association
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Calgary Health Region
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David Thompson Health Region
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Capital Health
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Alberta Health and Wellness
The pilot involved:
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Three cities: Edmonton, Calgary and Red Deer.
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13 orthopaedic surgeons.
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One Hip and Knee Replacement Clinic in each city: Health First Strathcona in Edmonton; Health Resource Centre (HRC) in Calgary; and Central Alberta Hip and Knee Clinic in Red Deer.
- Where can I find information about the different types of artificial joints that are used in total hip replacement?
The hip is a ball-and-socket joint - so-called because the rounded head of the femur (the main bone in the thigh) fits into a cup-shaped cavity in the hip. Ball-and-socket joints allow for a wide range of movement.
There are many types of artificial joints used to replace the total hip. These usually consist of three components:
1) a cup that replaces the hip socket;
2) a ball that replaces the head of the femur; and
3) a stem extending from the ball that is inserted into the shaft of the femur as an anchor.
Some of the more commonly used artificial joints are: metal on plastic using a combination of metal and polyethylene components, metal on metal using only metal components, and ceramic on ceramic using a combination of ceramic and metal components.
Metal on plastic usually consists of a metal stem, ball and socket and a polyethylene liner placed inside the socket.
Metal on metal is comprised of a metal stem and ball and a metal cup, and sometimes includes a metal liner.
Ceramic on ceramic is comprised of a metal stem and cup, ceramic ball and a ceramic liner.
The stem for these prostheses is sometimes cemented into the shaft of the femur. Further information on these and other types of artificial joints can be found by doing a search on the Web and/or discussing the options with your surgeon.
- Where can I find information about the different types of devices that are used in hip resurfacing?
A hip resurfacing device usually consists of a metal cap that replaces the head of the femur, and a cup-shaped insert for the hip socket.
Hip resurfacing entails removing the diseased surface of bone within the joint and covering these areas with metal implants. This typically involves removing the surface of the head of the femur - the main bone in the thigh - and reshaping it to accept the metal cap, which has a short stem that is inserted into the femur. The surface of the hip socket - the curve-shaped cavity into which the femur fits - is also removed and a cup-shaped metal implant is inserted. The new surfaces are chromium-cobalt and together form a metal-on-metal surface in the hip joint.
Portions of the device are cemented into place. Further information on this and other types of prostheses can be found by doing a search on the Web and/or discussing the options with your surgeon.
- Where can I find information about the different types of artificial joints that are used in total knee replacement?
There are many types of artificial knee joints but they are generally either cemented or uncemented.
An artificial knee joint is made of metal and plastic and has three components:
1) a tibial component that replaces the top of the shin bone;
2) a femoral component that replaces the grooved end of the thighbone where the kneecap sits; and
3) a patellar component that replaces the bottom surface of the kneecap that rubs against the thighbone. (You can feel the top of the kneecap through your skin. The bottom of the kneecap slides up and down in the groove of the thighbone when you bend or straighten your leg.)
The femoral and patellar components are made of metal. The tibial component is usually made of two parts - a metal tray that is fitted directly onto the bone, and a plastic spacer that provides a bearing surface.
In a cemented joint, the patellar component is held in place using an epoxy that cements the metal to the bone. In an uncemented artificial joint, the surface of the patellar component has a fine mesh. The bone grows into the mesh and attaches naturally to the bone.
In some cases, a combination of the two types is used.
In a normal knee, four ligaments help hold the bones in place so that the joint works properly. When a knee becomes arthritic, these ligaments can become scarred or damaged. During knee replacement surgery, some of these ligaments, as well as the joint surfaces are replaced by the new artificial joint.
Further information on these and other types of prostheses can be found by doing a search on the Web and/or discussing the options with your surgeon.
- Where can I find information about the different types of artificial joints used in partial knee replacement?
An artificial joint for partial knee replacement is often referred to as a uni-compartmental knee and consists of metal and plastic components. A plastic insert, made of polyethylene, replaces damaged cartilage. The insert is attached to the metal component that replaces the bone. Further information on this and other types of prostheses can be found by doing a search on the Web and/or discussing the options with your surgeon.
