Osteoarthritis (OA) Hip and Knee Service

The OA Hip and Knee Service is a new service which is available at a number of public hospitals in Victoria.  The service aims to optimise the management of patients with hip or knee OA and improve the management of outpatient and elective surgery waiting lists. 

This website is hosted by the Centre for Rheumatic Diseases and Melbourne Health, to provide information to health services, referring health providers and consumers.  It includes:

• Background – Why an OA Hip and Knee Service?
• Information for health services providing the service
• Information for general practitioners and other health professionals whose patients may be seen by the service
• Information for consumers who may be referred to the service.

For implementation advice contact:

Lisa Clough
Improvement Manager
Orthopaedic Waiting List (OWL) Project
Melbourne Health
Ph: 9342 4569
Email: Lisa.Clough@mh.org.au

The growth of joint replacement surgery (JRS) in Australian public hospitals is well-documented, with current evidence indicating a continued increase in demand for hip and knee JRS.  However, waiting times for both outpatient assessment and surgery can be prolonged and may lead to further worsening of a patient’s physical condition as well as their psychosocial wellbeing.

Number of hip and knee replacement procedures from 1994-1995 to 2005-2006

Waiting for joint replacement – the impact

Long waits:  In Australian public hospitals in 2004-2005, the median waiting time for elective orthopaedic surgery was 48 days, exceeded only by ophthalmological surgery at 66 days1.  A ‘median’ waiting time of 48 days means that half of the patients wait more than this time – many for over a year.  Waiting times for an orthopaedic outpatient appointment can also be protracted.

Patterns of referral to orthopaedic outpatients: The decision to refer patients for outpatient orthopaedic assessment in the public health system is not always straight forward and there is a tendency amongst general practitioners (GPs) to refer patients before they actually require surgery.  This practice is driven by GPs’ concerns about long waiting times for orthopaedic assessment and joint replacement surgery.  GPs may also refer patients to the orthopaedic outpatient clinic to secure access to public allied health services or for a second opinion.

Significant health and economic costs:  There is evidence that waiting for surgery may lead to further worsening of a patient’s condition, including their overall physical and psychosocial wellbeing2-4, which in turn can impact negatively on surgical outcomes5.  This is in part due to inadequate conservative management in the lead-up to surgery3,6,7.  There is also evidence of significant cost to the community in terms of direct medical costs and indirect costs such as lost productivity.  Accordingly, Access Economics identifies potential value in managing waiting lists more effectively and for optimising disease management prior to surgery, including self-management1.

Opportunities for service improvement

• System challenges: The problems and health impacts associated with long waiting times both for surgery and outpatient consultations reflect a number of problems with current service delivery systems, including:
• the lack of standardised care according to best practice guidelines;
• restraints related to specialist and operating theatre resources; and
• inadequate coordination between and within health care services.
  
  
• System improvements: In order to address these issues, effort is required at each stage of patient management, including:
• facilitation of the referral process to orthopaedic outpatients;
• optimisation of patient management in the lead up to orthopaedic consultation and surgery;
• effective prioritisation of surgical service delivery to match patient need;
• appropriate access to surgical services; and
• appropriate access to allied health services.

The OWL Project has sought to realise these opportunities for improvement.  It is being conducted in three stages:

Stage I (2004 - 2006):
This involved the development of a tool that prioritises people with hip or knee joint disease for surgery. Click here to download Stage 1 Report.

Stage II (2006 – 2007):
This involved the development and piloting of a service delivery model that incorporates the prioritisation tool to facilitate optimal management of people who may require JRS.

Stage III (2008-2009):
This involves the extended implementation to a further 10 Victorian hospitals in order to reduce the burden of disease in the Victorian community.

References

• Access Economics Pty Ltd. Painful realities: the economic impact of arthritis in Australia in 2007. July 2007.
• Sanmartin C. et al., Access to Health Care Services in Canada. Ottawa: Minister of Industry, 2004. 2003
• Ostendorf M. et al., Waiting for total hip arthroplasty: avoidable loss in quality time and preventable deterioration. J Arthroplasty, 2004. 19(3): p. 302-9
• Fielden J. et al., Waiting for hip arthroplasty: economic costs and outcomes. J Arthroplasty, 2005. 20(8): p. 990-7.
• Ackerman IN, Bennell KL. Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review. Australian Journal of Physiotherapy, 2004. 50: 25-30.
• Osborne RH, Buchbinder R, Ackerman IN. Can a disease-specific education program augment self-management skills and improve Health-Related Quality of Life in people with hip or knee osteoarthritis? BMC Musculoskeletal Disorders, 2006. 7: 90.
• Ackerman IN, Graves SE, Wicks IP, Bennell, KL & Osborne RH. Severely compromised quality of life in women and those of lower socioeconomic status waiting for joint replacement surgery. Arthritis Care and Research, 2005. 53, 653-8