Wait Times for Hip and Knee Replacement

Hip replacement and knee replacement are major surgeries, and patients must be prepared in every way for what they are going to experience. The process of preparing for surgery is called optimization, and it is designed to bring patients to their optimal state of readiness — medically, physically and socially — for surgery. Patients who are optimized are more likely to enjoy a successful recovery and return to normal function.

The ideal wait time for surgery is not zero.

Rushing directly to surgery without taking the time to optimize for it will very likely result in poorer outcomes. The Alberta model of care for hip and knee replacements recognizes this and builds in time for patients to reach their optimal readiness for surgery. This means the time leading up to surgery is not spent waiting idly.

To start the optimization process, patients undergo a series of tests. These may include:

• Blood tests;
• an electrocardiogram (EKG or ECG); and
• assessment by an internal medicine doctor and an anaesthesiologist.

A customized optimization plan is prepared by the patient’s care team. The plan includes steps that may be needed to resolve or stabilize a medical condition, such as high blood pressure, anemia (low iron), and diabetes, so that it does not negatively affect the patient’s recovery.

Surgery could be delayed until blood sugar levels are reduced, a weight target is reached, or strength is gained. Medications may need to be adjusted.

Lifestyle changes are sometimes necessary for a successful surgery and recovery. These may involve:

• Changes in diet to correct nutritional deficiencies.
• Stopping tobacco use.
• Doing exercises to build the strength and flexibility needed during recovery, especially when using a walker, crutches or cane.
• Installing equipment in the home, such as grab bars and raised toilet seats, to make recovery safe and easier.

Among the most important steps when preparing for surgery is to find a support person who will provide both emotional and hands-on help leading up to surgery and during the recovery at home. This may involve:

• Going with the patient to medical appointments and teaching sessions about hip and knee replacement.
• Helping to find and install the equipment, such as grab bars, raised toilet seats and toilet armrests, that patient will need at home for a safe, successful recovery.
• Translating information if there is a language barrier.
• Driving the patient to the hospital for surgery and home for recovery.
• Helping with bathing and other personal needs.
• Changing bandages and taking blood thinner injections.

You can reduce your wait for a consultation or surgery by selecting the next available surgeon at your referred clinic. This option is available at almost all Hip and Knee clinics in Alberta. To find out if this option is available to you, speak with the care provider who submitted your referral.

Taking the next available surgeon at your referred clinic for your hip or knee problem can reduce your wait by weeks and, in some instances, months.

Waiting times for orthopaedic procedures are a complicated topic because there are so many variables that go into how long someone waits for care.

Part of the issue relates to the growing demand for surgery and surgeon consultation. Canadians are living longer than ever before and obesity is increasing in the general population. This puts more stress on our joints, which can accelerate the effect of osteoarthritis and increase the demand for joint replacement. On average, the volume of joint replacement surgery in Alberta has grown by 6.4% every year since 2003.

Another factor is related to patient choice. ABJHI has been examining information that shows wait times for hip and knee replacement patients from two different starting points:

• The date they decide to have surgery, and
• The date they are actually ready to have surgery.

There is often a big difference between the two waiting periods. Some patients choose to postpone their surgery out of convenience or unavoidable family commitments – a vacation, a wedding, or a heavy workload. But provincial wait times aren’t adjusted to account for these “convenience” delays. Instead, the clock continues to run even when patients postpone their surgery. This makes the wait time appear long and the fault appear to be with the health system. Be certain when you decide to go ahead with surgery that you will be available for it when your surgery date arrives.

Finally, studies show that almost one in three patients fails to show up for scheduled tests and services. Missed appointments are very costly in different ways: they leave expensive equipment idle, they create unproductive time for busy care providers, and they prevent others from being seen during that appointment which increases waiting times for everyone. If you can’t make an appointment, cancel or reschedule it as far in advance as possible so that another patient can have a test or see a care provider sooner.

If your schedule is flexible, ask to be put on your care provider’s cancellation list so that when a patient cancels an appointment, you have a chance to fill the slot and reduce your wait time.

If you're interested in learning more, ABJHI prepared a White Paper on the topic of care for osteoarthritis patients in Alberta.