In an effort to decrease lengthy wait lists for joint replacement surgery, the Orthopaedic & Arthritic Institute (OAI) of Sunnybrook and Women’s College Health Sciences Centre has begun a new initiative with the Ontario Joint Replacement Registry (OJRR) for the collection of hip and knee replacement patient information.
As the first coordinated hospital-based model in Ontario, the collection of data from the OAI is expected to provide greater consistency in joint replacement information. As well, one of the objectives of the OJRR is to reduce the number of surgical revisions in Ontario. It is believed that over time, the OJRR data will help improve outcomes by allowing professionals to monitor the effectiveness of various techniques and technologies.
According to Dr. Jeffrey Gollish, an orthopaedic surgeon and Head of Arthroplasty Services at the OAI, “Seniors are the fastest growing population and with surgical hip and knee success rates very high, we continue to see an increase in patient referrals. We are also seeing an increasing demand from the aging Boomers who want to continue their active lifestyle. Our coordinated involvement with OJRR will help manage the long waiting lists and demand for replacement surgery. Our goal as surgeons is to decrease waiting lists and improve patient access to care. Having accurate and complete data will facilitate this process.”
As of January 31, 2005, every patient undergoing joint replacement receives a consent form and an information package about the OJRR. Patients are asked to complete a simple questionnaire that assists with determining their level of disability based on The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The WOMAC is a widely used measure of symptoms and disability related to arthritis and evaluates three dimensions: pain, stiffness, and physical function.
The data collected pertains to three key areas: waiting times to see an orthopaedic surgeon for an initial consult, waiting times from consultation to the actual surgery, and finally surgical data. Information is then exchanged with the OJRR through two separate web-based submissions: an initial summary and a surgical report.
At present, 190 orthopaedic surgeons participate in the OJRR. The OJRR data is also shared with the Canadian Registry. Up until recently, orthopaedic surgeons at the OAI collected data for the registry on a voluntary individual basis.
Osteoarthritis is the main reason for the ongoing and increasing demand for hip and knee joint replacements. It is estimated that there are about 20,000 patients currently waiting for joint replacements in Ontario.
Basically with osteoarthritis, the cartilage that provides cushioning between bones and in the joints begins to thin and sometimes even breaks off. The broken cartilage floats around the joint space impeding movement and irritating tissue. For some patients the cushion disappears altogether and they present with bone rubbing on bone. This results in pain and discomfort. Patients suffer tremendously while they wait months and even years to have surgery.
Despite long waiting lists, there is positive news for hip and knee replacement patients. Stats show that the average length of stay in hospital for hip and knee replacement patients has dropped in the last eight years. With no compromise in outcomes. There is also better pre-operative patient education, less invasive surgery, better pain control methods and better post-operative rehabilitation available.
“We’re delighted to have the OAI’s full support. With a dozen surgeons taking part in the registry, the OAI will be very well represented,” says Susan Warner, Managing Director of the OJRR.