It's much faster to get hip or knee replacements if there's a central waitlist: study

Amina Zafar · CBC News

· Posted: May 20, 2025 4:00 AM EDT | Last Updated: 10 minutes ago

Canadians who request a hep oregon genu replacement could get the country much rapidly — without adding to health-care budgets oregon opening much operating rooms — if cardinal waitlists were created, the writer of a caller survey says. 

The findings, published successful Tuesday's contented of the Canadian Medical Association Journal, suggest it's importantly faster to adhd patients to a cardinal database wherever they tin spot immoderate surgeon successful their area, compared to each surgeon having their ain waitlists. 

Right present successful Ontario, a superior attraction provider, specified arsenic your household doctor, refers you to a surgeon oregon physiotherapist to determine whether country is needed. If it is, you'll beryllium enactment connected 1 surgeon's waiting list, which could beryllium agelong oregon short. 

Often, it's a agelong hold — successful Canada, lone two-thirds of patients person their hep replacement wrong the 26-week recommended standard, according to information from the Canadian Institute for Health Information. For genu replacements, lone 59 per cent are done wrong that time.

So that's prompted immoderate provinces to experimentation with however they delegate country patients to waitlists, with the extremity of shortening wide hold times.

For the study, Dr. David Urbach, caput of the country section astatine Women's College Hospital successful Toronto, and his squad compared 3 models based connected information collected from much than 17,000 patients crossed Ontario who were referred for hep oregon genu replacements successful 2017. 

The 3 models were:

• Option 1: A household doc refers you for appraisal to a excavation of surgeons oregon physiotherapists successful the portion of the state wherever you live. If you request surgery, you're assigned a surgeon and enactment connected their waitlist.

• Option 2: The household doc refers you to a circumstantial surgeon oregon physiotherapist to determine whether country is needed. If you request an operation, past you're enactment successful a excavation for the adjacent disposable surgeon successful the portion of the state wherever you live.

• Option 3: A operation of the archetypal two: Your household doc puts the petition for appraisal into a cardinal excavation — and, if you request surgery, you participate a 2nd excavation that includes each the qualified surgeons successful your country and would spot the adjacent 1 available.

Currently, patients awaiting associated replacements are similar customers astatine a market store, Urbach said successful an interrogation — they're stuck successful a line, adjacent if different checkout opens up. 

But the amended enactment for country would beryllium akin to going to the bank, wherever everybody moves done a communal enactment and waits the shortest imaginable time.

WATCH | Hospital replaces hips successful 35 minutes:

When it comes to hold times, Urbach said the survey recovered that random factors tin harvest up and dilatory down 1 surgeon — similar 1 having an already agelong hold database and constricted operating country clip successful a much agrarian area. 

Shorter waits with caller system

Priority for associated replacement country besides depends connected criteria similar the grade of symptom and disablement and the hazard of a worse result with a hold successful surgery.

In Ontario, the extremity is for a diligent to hold nary longer than six months for a consultation, with the maximum hold for the country itself being different six months, the researchers said.

For apical precedence cases, 90 days is the people hold clip for those connected a azygous surgeon's list, portion the survey recovered that comparable patients successful the determination excavation made it done successful 84 days.

In the study, Option 3 — wherever determination was a cardinal intake for consultation and for country — astir halved hold times for the immense bulk of patients successful each regions, ranging from 111 less days successful Toronto (from 257 to 146 days) to 281 days successful Ontario West (from 536 to 255 days).

Much of the hold clip for associated replacements was for the country itself and not the consultation, the researchers found.

"Unless you present a team-based exemplary of care, you conscionable person to hold until a spot opens up and that could beryllium precise long," Urbach said. "That could beryllium a year, year-and-a-half oregon longer."

Getting surgeons to bargain in

Canadians whitethorn person heard of team-based superior care, wherever patients person entree to a well-connected interprofessional squad specified arsenic household doctors, caregiver practitioners, societal workers and dietitians.

Similarly, successful team-based surgical care, a radical of surgeons takes the adjacent diligent successful bid of priority, adjacent if a patient's peculiar surgeon has a precise agelong list, Urbach said.

Asked what benignant of absorption surgeons person fixed to team-based surgical attraction truthful far, Urbach said galore are skeptical astir moving distant from keeping their ain database of patients.

"They're acrophobic that they'll suffer their root of referrals," Urbach said.

Dr. Olufemi Ayeni, president of the Canadian Orthopaedic Association and an orthopedic surgeon astatine McMaster, said helium sees that presumption dissipating among those successful the profession.

"I deliberation determination volition beryllium immoderate openness and there's decidedly been a civilization displacement wrong orthopedics," Ayeni said. "We don't similar proceeding astir patients who are suffering, needing symptom medications. It feeds into different concerns [such as] opioid use."

The study's authors acknowledged that unless surgeons judge that team-based models of attraction are beneficial to them and bash not endanger their autonomy oregon opportunities for income and nonrecreational advancement, "these models of attraction are improbable to beryllium viable successful Canadian wellness systems successful which physicians are highly independent."

Ayeni agreed, saying different the effect to team-based attraction among surgeons volition beryllium muted.

Mohamed Alarakhia, a household doc and managing manager of the non-profit eHealth Centre for Excellence successful Kitchener, Ont., uses e-referrals for specialists. Alarakhia said it has already reduced orthopedic hold times by 54 days.

Wait times crossed Canada

Using a cardinal intake for some appraisal and surgeries equalizes hold times wide among surgeons, Alarakhia said.

"We person examples successful this state of wherever we've figured it retired and crossed the state wherever they've done cardinal intake," Alarakhia said, giving Quebec and Alberta arsenic examples.

"I judge we tin lick these problems if we get immoderate of these things successful place."

Health PEI said it's present adopting a centralized waitlist absorption strategy for surgical care, including hep and genu replacements.