Local wait times for knee and hip replacement surgery remain among the lowest in the province with help from a joint assessment centre that officially opened, November 3, at the West Parry Sound Health Centre (WPSHC).
Local hip, knee replacement wait times second lowest in Ontario.
The Parry Sound Joint Assessment Centre that officially opened November 3 at the West Parry Sound Health Centre (WPSHS), provides a central point of intake for patients suffering from hip and knee problems. In the past nine months 263 patients have been assessed. The local centre is one of five opened by the LHIN in the past 20 months, including Sudbury, Timmins, and Sault Ste. Marie, as well as North Bay to be officially opened later this month. Shown at opening ceremonies at the WPSHC (from left) are Debbie Junk-Lloyd, manager of clinical services; Leah Welk, local representative/board director N E LHIN; Rebecca Cutler, advanced practice physiotherapist at the joint assessment centre; Dr. Bill Smyth, orthopaedic surgeon at the centre; Sonya Parks, Co-ordinator/IT support; and Donald Sanderson, CEO WPSHC.
Charlene Peck photo
In July, August and September, the local health centre had the second lowest wait times in the province for knee and hip replacement surgeries.
Based on the Ontario Ministry of Health and Long Term Care wait times - described as the number of days to complete the surgery for nine of ten patients - WPSHC had a wait time of 55 days for knee replacement surgery, the second lowest provincially, just behind Brantford General Hospital at 48 days. WPSHC’s wait time for hip replacement surgery also ranked second lowest in the province at 62 days, behind Brantford General Hospital’s 48 days.
“One of the strategies being used across the province to reduce the wait times, is through the establishment of joint assessment centres,” says Bruce Villella Wait Times Lead with the North East Local Health Integration Network (LHIN), pointing out that a significant reduction in wait times reduction was achieved in Sudbury with its joint assessment centre.
Villella says that since the joint assessment centre began operating in West Parry Sound in September 2010, there has been improvement in wait times for hip and knee replacement surgery.
“But on an already good rate,” he notes. “The wait time in Parry Sound was always very good, they managed to keep their wait way below the 182 day target set by the province, so we’ve never had an issue.”
Currently, patients wait four or five weeks to be assessed at the local centre after being referred by their family physician.
If they are considered candidates for surgery and choose the local orthopaedic surgeon, Dr. William Smyth, they are usually seen by him that day. If hip or knee replacement, is the course of action agreed upon with the surgeon, the average local wait time for that surgery is four or five weeks.
“People see their family doctor, and they may be having problems with arthritis in their hip or their knee,” explains Rebecca Cutler, an advanced practice physiotherapist with the joint assessment centre at the West Parry Sound Health Centre.
“They would be referred to the joint assessment centre to assess the extent to which the arthritis is impacting mobility and determine readiness for a total knee or hip replacement. If surgery is not the best option, they are given options for conservative management of hip and knee arthritis. These options may include anti-inflammatory medications, corticosteroid injections, and/or physiotherapy.
“I assess range of motion, function and pain. I review x-rays with Dr. Smyth and I talk with patients about what options they might want to try,” she explains.
"We also discuss the role of exercises and strengthening and whether it is possible based on their symptoms, and I also screen for other health concerns needing consideration prior to embarking on a surgery.
“I help educate people about their options for managing arthritis and help people feel better prepared for a total joint replacement if they go on to have surgery".
The assessment clinic operated by the physiotherapist runs concurrently with Dr. Smyth’s clinic.
“If people are appropriate for surgical consideration, they will see Dr. Smyth during the same visit,” Cutler explains.
“It works very well,” she says. “I think it has improved wait times indirectly, by helping screen people who are appropriate for surgery. So basically, Dr. Smyth is spending more of his time with patients who are going to have surgery. And I spend more time educating people about their options - perhaps they’re not ready to have a knee replacement because they are too young and have not exhausted conservative alternatives.”
Currently knee replacements last 8 - 10 years in people who are over 65, have an average build and an average activity level, she explains.
If one of these criteria is not met the joint replacement will likely fail sooner.
Unfortunately when the knee replacement is revised or re-done the outcomes are much less predictable.
Feedback about the WPSHC joint assessment centre over the past year has been positive.
“I get the impression that (the patients) really appreciate the time that I spend educating them about arthritis and their options,” she says.
Having Cutler working simultaneously in Dr. Smyth’s office at the WPSHC joint assessment centre offers patients a unique advantage.
In other joint assessment centers in the Northeast LHIN the therapist refers patients to see a surgeon, if surgery is deemed appropriate.
Patients are given the option to have the next available surgeon in the LHIN or a specified surgeon.
In Parry Sound, patients also have this option, and are asked if there is a specific surgeon they’d like to see, or a location in the LHIN for surgery they would prefer.
Having Dr. Smyth working simultaneously in the same location, reduces thewait time to zero between therapist assessment and the patient consulting with a surgeon.
Patients suffering from knee or hip arthritis can be referred to the joint assessment centre by their physician or nurse practitioner.
For information about Ontario surgery wait times see www.waittimes.net