Alberta’s Patient-reported Bone and Joint Outcomes on the International Stage

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The Organisation for Economic Co-operation and Development (OECD) has published their biennial Health at a Glance report, detailing the latest international data and trends on health system performance and measures for population health.

A key section of the report looks at measuring health from the patient perspective, an increasingly valued model for health systems and research. Metrics looking at pain, function and quality of life encourage healthcare providers and policy makers to focus on the effectiveness of health care services, a key component to increasing health system sustainability in the face of a growing and aging population with increasing levels of chronic health conditions. 

Alberta contributed to the analysis of patient-reported outcome measures (PROMs) for hip and knee replacements alongside national initiatives (England, the Netherlands, Sweden), regional initiatives (Manitoba and Geneva, Switzerland), sub-national registries (Australia) and single hospitals (Coxa Hospital, Finland and Galeazzi Institute, Italy).

The OECD reports that over 2.2 million people undergo an elective hip or knee replacement each year in the 36 OECD countries. Data in Alberta shows that more than 10,000 of these surgeries are performed each year, with demand continuing to outpace capacity.

The EQ-5D is one of the standardized PROMs collected for hip and knee replacement surgeries in Alberta and was included by OECD in their analysis. The EQ-5D survey measures overall quality of life and can be used to calculate quality-adjusted life years (QALYs). A QALY of 1.0 is the same as living one year in perfect health or living two years at half that quality of life. QALYs are commonly used by health economists to measure whether procedures are cost-effective.

Albertans who have an elective hip or knee replacement (i.e. not an emergency procedure to repair a broken hip or knee) answer the EQ-5D before surgery, 3 months after surgery, and 1 year after surgery. The international comparison done by OECD shows that, on average, a 65-year old person with end‑stage osteoarthritis who underwent a hip replacement received 4.3 additional QALYs. In other words, they gained the same as 4.3 years of perfect health compared to before the surgery. Similarly, those who underwent a knee replacement received 3.3 additional QALYs.

“Not only does this report re-confirm that hip and knee replacement surgery is a highly effective procedure for people with severe osteoarthritis,” said Christopher Smith, Director of Technical Operations for ABJHI, “but it also demonstrates that Albertans are receiving similar benefit to some of the most highly-regarded health systems in the world, like Sweden and England. However, we still have room to improve as we strive to deliver the world’s best outcomes for Albertans suffering from bone and joint disorders.”

ABJHI collects pre-surgery and post-surgery PROMs on behalf of the 96 surgeons who participate in the provincial bone and joint health quality assurance program, in partnership with the Bone and Joint Health Strategic Clinical Network. ABJHI would like to acknowledge these partners for their efforts in collecting these patient outcomes and the tens of thousands of patients who take the time to complete these valuable surveys. Every tick box makes a difference.

Citation: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris,

For general information on the EQ-5D, the EuroQol Research Foundation recently published an animated video, which is available on Youtube: