Wait times plunge for joint replacement surgery

BY RUTH REID

A new assessment clinic in Sudbury is making a huge difference for northerners needing hip and knee replacements.

The North Eastern Joint Assessment Centre (NEJAC) at Sudbury Regional Hospital consists of an advanced practice physiotherapist and a support secretary. Funding for the clinic was provided by the North East LHIN in support of the Ministry of Health and Long-Term Care’s strategy for shortening wait times for hip and knee surgery.

Since it began operating in 2010, the clinic has drastically reduced the time clients wait before receiving their orthopedic surgery.

Before 2009, most patients in the Sudbury area in need of hip or knee replacement surgery would wait an average of 18 months to three years.

Now, statistics show the average wait time from first referral by a family physician to actual surgery is about six and a half months. And, in many cases, the wait is even shorter  - just over four months.

With that kind of track record, the North East LHIN is optimistic that other joint assessment centres being established in the region will mean more and more northerners will be able to get the surgery they need in a timely manner and in a hospital close to home.

Joint assessment centres were also scheduled to be up and running at the West Parry Sound Health Centre, the North Bay Regional Health Centre and Timmins and District Hospital by February, and a Sault Ste. Marie clinic is supposed to be in operation by June.

Southern Ontario

Dr. Eric Robinson, lead orthopedic surgeon at Sudbury Regional Hospital, says historically, many patients in need of joint surgery have opted to go to southern Ontario for the procedure because wait times at hospitals there were much shorter than in the northeast.  But now, with the establishment of the joint assessment centres, a much larger percentage of patients from across the northeast are able to have their surgery done locally. It’s much better for most patients to be close to home, where they have the support of friends and family, and fewer worries about travel and accommodations, said Robinson.

There are several reasons for the drop in surgical wait times, according to Renee-Anne Wilson, the advanced practice physiotherapist at the Sudbury joint assessment centre. One of the most important changes for patients is the quick turnaround time from their doctor’s referral to their first assessment.

Patients receive an appointment for a consultation with Wilson within four to six weeks of being referred to a Sudbury orthopaedic surgeon. This is a huge change for patients who used to have to wait up to two years to see a surgeon.

“I can tell them within about half an hour whether they’re a candidate for surgery or not,” said Wilson, who does a thorough physical examination of the affected joint, and reviews the patient’s X-rays and other work-up documents with them.

“We’ve found that this initial intake eliminates about 40 per cent of patients from the surgeons’ waiting lists. That’s because the clients either don’t actually need surgery, or they decide they don’t want surgery. ”
If a patient isn’t a candidate for hip or knee surgery, Wilson can help them decide on other treatment options.

This new approach, along with other measures taken by Sudbury Regional Hospital over the last few years, continues to shorten the wait times for joint surgery.

More OR time

Other factors responsible for speeding up surgery include the hiring of two more orthopedic surgeons, the allocation of more operating room time for hip and knee replacements, the designation of dedicated beds for surgical patients and the hiring of another operating room nurse.

Robinson points out that having dedicated beds means joint surgery rarely has to be cancelled when the hospital has a bed shortage. Sudbury Regional Hospital has made cardiac, cancer and joint replacement surgeries a priority, and is already very close to the Ministry of Health goal of completing 711 joint surgeries by the end of this fiscal year.

Once the other designated hospitals in the northeast have their own joint assessment centre, they too may decide to make changes in the way their orthopedic services are offered. Each hospital decides on its own how it will work with the centre and where it will find the money to facilitate more joint surgeries.

Robinson says anyone considering hip or knee replacement should take comfort in knowing that these surgeries are very predictable and successful. He says the number one reason for surgery is pain reduction. Second is quality of life.

Most hip and knee replacement surgeries take about one and a half to two hours, and most patients can return to the activities they love after an average recovery period of four to six months.

“Sure, there are some cautions, but I usually tell my patients to ease back into their routines, and perhaps choose a more gentle approach. For example, take the frequency of the hockey, jogging or tennis down a couple of notches, and don’t go at it as hard as before surgery,” he advised.

The artificial joints are made of a variety of materials, including stainless steel, titanium, ceramics and various plastics. The major risks involved in joint replacement surgery are blood clots, infection and potential nerve damage. According to Robinson, serious complications like these occur less than two per cent of the time. With care, and depending on the physical demands and lifestyle of the patient, most joint replacements will last 15 to 20 years.

Ruth Reid is a Sudbury-based freelance journalist.