Hip and Knee Replacement Surgery
Toolkit: a 'living document' 

Hazel Wood, BSC OT, MBA
Executive Director, Bone and Joint Canada 

Rhona McGlasson, RPT, MBA
Program Director, Bone and Joint Health Network, Ontario 

James P. Waddell, M.D., FRCSC
National Action Network Coordinator, Bone and Joint Decade Canada, Bone and Joint Canada 

Cy Frank, M.D., FRCSC
Executive Director, Alberta Bone and Joint Health Institute 

The Hip & Knee Replacement Surgery Toolkit, a "living document", has been released on the Bone and Joint Canada web site (www.boneandjointcanada.com). This completes Phase III of the Hip & Knee Wait Times Initiative that was undertaken with funding from Health Canada and in-kind support from the Canadian Orthopaedic Foundation and the Alberta Bone and Joint Health Institute (ABJHI).

The Toolkit consists of two parts. There is a High Level Outline of the Core Model of Care that stipulates the minimum requirements for providing the National Core Model of Care to people requiring total hip and knee surgery. The Core Model promotes the use of central intake, formalized assessment and surgical procedures, as well as consistent postoperative care. The second component is a Resource Folder on the web site that provides sample documents to assist those wanting to develop systems based on past experience. The Resource Folder provides sample intake forms, care pathways, educational programs and guidelines for transfer from one level of care to another.

At the March 2009 meeting of the National Hip and Knee Knowledge Translation Network in Toronto, the Toolkit was presented and the key opinion leaders developed next steps and recommendations for use of the Toolkit including:   

1. Disseminate and promote the Toolkit
   Dissemination and marketing of the Toolkit and resources is required across the country through all the individuals who supported its development to facilitate its use and improve clinical practice. Uptake will be enhanced through identification of local champions to promote its use to government, health care administrators, surgeons, clinical teams, primary care providers, and the public at large.
2. Expand the National Network
   Continue to develop a National Network to promote sharing of clinical practices and build on the learnings at a local, regional and provincial level.
3. Engagement of rural and remote primary care providers
   Continue to engage primary health care providers and allied health practitioners, with greater representation from rural and remote communities to promote and stimulate cross country networking and to ensure comprehensiveness applicability and utility of the Toolkit. 
4. Develop tools for primary care practitioners
   Develop tools to assist primary care physicians in the management of surgical patients both preoperatively and following their surgery to maximize the patients' functional recovery.
5. Ensure sustainability of the Toolkit
   The Toolkit is meant to be a "living" document that will require ongoing maintenance to provide the most up-to-date resources related to hip and knee replacement surgery. In order to ensure the sustainability of this endeavour, appropriate funding, stewardship and promotion of the Toolkit will be required.
6. Wait times tool development
   A separate Toolkit is currently being developed which provides many of the tools required to develop and utilize a wait times system such as capacity planning and modeling. 
7. Further develop the Toolkit to ensure best practice for hip and knee replacement surgery
   a. A comprehensive international review of articles with direct relevance to the Toolkit would help to address the paucity of evidence.
   b. A formal evaluation of the systems and the results following implementation would be of benefit to measure the impact of the Toolkit's use in the field. Phase III of this project established face validity (i.e. key opinion leaders determined that the Toolkit will likely be effective).
8. Facilitate and refine data collection
   A number of indicators have been identified for evaluation of clinical practice related to the Core Model of Care. These indicators can be further refined through clearer definitions to allow for local, regional and provincial data comparison.
9. Establish a clear funding model for hip and knee replacement surgery
   Funding should be based on a sound business model that clearly identifies the necessary human and financial resources and follows the patient across the care continuum. This will ensure access to efficient quality care for hip and knee replacement surgery.

Bone and Joint Canada will be working with stakeholders and partnering organizations over the next few months to promote and facilitate the use of the Toolkit and will investigate opportunities to access the funding necessary to move ahead with the identified next steps.

Orthopaedic surgeons across Canada are invited to register at www.boneandjointcanada.com and download the Toolkit and the Resource Folder. Feedback can be provided on the site or to Dr. James Waddell at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .