Purpose: Elective total hip and knee replacement surgeries are effective procedures for patients suffering from hip and knee disease. The demand for joint replacements is expected to rise as the life expectancy of Canadians increases; thus putting a heavy burden on healthcare. In an effort to reduce the acute hospital length of stay (LOS) the Alberta Orthopaedic Society, with the Alberta Bone and Joint Health Institute, three Alberta health regions (Calgary, Capital and David Thompson) and Alberta Health and Wellness created an evidence based new care continuum for hip and knee replacement. The LOS through the new care continuum compared to the current conventional approach was evaluated. In addition patient characteristics that could potentially predict the LOS were evaluated.

Method: The study design was a randomized, controlled trial. Consenting subjects were randomized to receive care through either the new care continuum (intervention) or the existing “current conventional approach” (control). Acute hospital LOS was calculated as the difference between the date and time the patient was admitted to the date and time the patient was discharged. Data was collected on patient characteristics potentially associated with acute hospital LOS.

Results: Intervention patients demonstrated a significantly shorter acute hospital LOS than the control patients, 4.66 and 5.95 days respectively. Further analysis of the data using a generalized linear model indicated that several patient characteristics were associated with a shorter/longer wait for consultation and surgery. Married patients had a statistically significant shorter LOS than single patients (IRR=0.89, p=0.001). Whereas older patients (IRR=1.01, p=< 0.001), patients with increased comorbidity (IRR= 1.03, p=0.001), and patients with an ASA of ≥ 3 (IRR= 1.22, p=< 0.001) resulted in a significantly longer LOS.

Conclusion: This study indicated that an evidence based healthcare continuum for the delivery of hip and knee replacements was successful in significantly reducing acute care LOS. Reducing the LOS using the new care continuum could potentially help alleviate the strain on limited healthcare resources and the savings could be reinvested to increase the numbers of joint replacement performed. Furthermore, an understanding of patient characteristics that influence acute hospital care LOS should be used to model surgical case mixing to further improve efficiencies.

Purpose: Total hip and knee replacements are recognized as effective surgical interventions for severe arthritis. Increasing demand for these services has led to increasing waits for both consultation and surgery. The Alberta Orthopaedic Society, with the Alberta Bone and Joint Health Institute, the Calgary Health Region, the Capital Health Region, the David Thompson Health Region and Alberta Health and Wellness carried out an analysis and an evidence based redesign of the care continuum for hip and knee replacement surgery in an effort to reduce wait times and improve the quality of service for patients.

Method: The study design was a randomized, controlled trial. Consenting subjects were randomized to receive care through either the new care continuum or the existing “current conventional approach”.

Results: During the 12 month study, 1570 patients received surgery. The mean wait for an orthopaedic consultation for intervention patients was 106 days compared to 200 days for the control patients. The mean wait for hip or knee surgery for intervention patients was 157 days compared to 408 for the control patients. Further analysis of the data using a generalized linear model utilizing negative binomial regression indicated that several patient characteristics were associated with a shorter/longer wait times. The less the severity of the disease pre-surgery was associated with a longer wait for a consult (IRR=1.01, p=< 0.001). Longer waits for surgery were statistically associated with less disease severity (IRR=1.004, P=0.019), documented delay (due to non-arthritic medical concerns or patient request for delay, IRR=1.61, p=< 0.001), increased comorbidity (IRR=1.03, p=0.015), and smoking (IRR=1.30, p=0.020).

Conclusion: The results of this study confirm that a redesigned joint replacement new care continuum with a standardized primary care referral process to centralized, specialized joint replacement clinics without established backlogs can help reduce wait times in Canada.

ACL deficiency can have detrimental pathological effects on the menisci in the knee. A database review in Quebec over a three-year period was previously reported (Canadian Academy of Sport Medicine, Winnipeg, 2003), which examined the relationship between waiting times for ACL surgery and the requirement of a meniscal procedure. The purpose of this study is to determine if the length of time between an index injury and ACL reconstruction (ACLR) surgery correlates with the incidence of meniscal repair and meniscectomy in Alberta, and to compare the results to those of the Quebec study.

Retrospective study, using procedure and billing codes to search the Alberta Health and Wellness databases for knees undergoing primary ACLR surgery between 2002–2005. Inclusion: Patients sixteen years or older at time of reconstruction. Exclusion: Revision ACLR, duplicate billing and coding, and insufficient database information. For each reconstructed knee, databases were searched for initial injury evaluation date with primary care physician, dates of meniscectomy or meniscal repair procedures, and date of ACLR.

Over a three-year period, there were 3382 primary ACL reconstructions performed in Alberta, 3812 ACLR in Quebec. Of these patients, 2583 in Alberta (76%) and 1722 in Quebec (45%) required a meniscal procedure. On average, Albertans waited 1389 days from injury to ACLR compared to 422 days in Quebec. In Alberta, patients not requiring a meniscal procedure waited 1212 days, patients requiring meniscal repair waited 1143 days, and patients requiring meniscectomy waited 1519 days, compared to 251, 413 and 676 days in Quebec, respectively. Three percent of patients in Alberta had ACLR < three months after injury (114 patients), with 45% requiring meniscectomy. Overall, 61% of patients in Alberta required a meniscectomy for significant meniscal injury, compared to 48% of patients in Quebec. The proportions for each province were statistically significant.

Compared to Quebec, patients in Alberta are waiting longer for ACLR, with only a small proportion of cases being treated acutely. The proportion of patients requiring surgery for significant meniscal injury is also greater in Alberta. The higher proportion of patients in Alberta requiring meniscectomy may be due to the delay in ACLR.