Long wait times for knee and hip total joint replacement in Canada: An isolated health system problem, or a symptom of a larger problem?

Abstract Introduction The wait times crisis for hip and knee arthroplasty has been a significant health care issue in Alberta and across Canada. Significant resource and financial efforts have been put forward to reduce wait times for surgical consults and surgeries as a means of treating patients with osteoarthritis, but after an initial shortening of wait times, they were not sustained and have expanded. Objective To effectively address wait times issues, an alternative perspective on this problem is presented – that the wait times are not the central problem, but rather wait times are a symptom of the much bigger issue of an inability of health care systems to accommodate the large number of patients with recently diagnosed OA or moderate OA who are not being effectively managed conservatively. Discussion In considering this alternative perspective, encapsulated by the concept of an “osteoarthritis funnel”, being continually filled with new patients and arthroplasty capacity being a bottleneck, we outline potential approaches for a solution on a systemic level that integrates services delivery, health care resource allocation and conceptualization of OA in on-going scientific activities. It also emphasizes the need for a more effective and relevant program of research to address this complex problem with its attendant potential for multiple etiologies for OA that may require unique solutions. Conclusions New approaches and understanding are needed to address development of effective conservative treatment of newly diagnosed osteoarthritis to prevent the constant and expanding demand for arthroplasty.