Editorial: We can do better with hip surgery

Wait times for hip-replacement surgery on Vancouver Island are among the longest in Canada. Last year, just 39 per cent of patients were seen within the national benchmark period of 182 days. Only one region of the country — Annapolis Valley in Nova Scotia — had a worse record.

Wait times for knee replacements were even longer. Just 26 per cent of these operations were performed within the 182-day standard. That placed Vancouver Island dead last in the national standings. Some patients waited well over a year for the procedure.

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Part of the blame might rest with a cluster of isolated events that are unlikely to happen again. Some specialists took maternity leave at the same time. There had been a fee dispute that led anesthesiologists to reduce their work hours.

Officials with Island Health are confident these short-term issues are solved. Additional anesthesiologists have been hired to work on the backlog, and some operations are being contracted out to private facilities. (Patients referred to a private clinic don’t have to pay, as the treatment is insured under the Medical Services Plan.)

But while things should improve this year, a much deeper problem lies behind these numbers.

Neither Island Health nor any other region in B.C. has ever come close to achieving the wait-time targets for hip and knee surgery.

Those benchmarks were set in 2004, when it became apparent patients were waiting too long for these procedures. The prime minister of the day, Paul Martin, gave the provinces $41 billion on the explicit understanding that performances would improve.

We don’t have figures back to 2004, but since 2008, there has been no meaningful improvement across our province. Even if last year’s dismal performance is excluded, we’re still nowhere near meeting the benchmarks.

And the reason is simple. The demand for orthopedic surgery has been growing dramatically.

Between 1995 and 2013, hip-replacement volumes rose 132 per cent in B.C. Knee replacements climbed 230 per cent. That’s about three to five times the growth rate in other surgeries.

These figures defy a demographic explanation. Patients 50 and over are the main recipients. But the demand for joint surgery has far outpaced the growth in this group.

Moreover, it has done so for most of two decades, and there is no sign of the trend moderating. Indeed, it appears to be gaining speed.

Part of the explanation is that older people are more active. That places a strain on aging joints. And new technologies have revolutionized the field. Many more patients can now be helped.

Of course, that’s wonderful news. A painful condition that once we had to live with can now be treated. But it places a huge strain on scarce resources.

Some of the backlog could perhaps be reduced with better management and co-ordination. Surgeons on Vancouver Island have introduced a new case-load system that evens out wait lists between doctors.

But given the sheer magnitude of the problem, part of the solution has to be more money.

How much? As a rough estimate, B.C. probably spends about $120 million on joint replacements. To meet the national benchmarks, something in the neighbourhood of an additional $40 million might be required. Possibly more.

Are we ready to make that kind of commitment? There are plenty of other calls on public funds.

The hard truth is that while arthritic hips and worn-out knees can be extremely painful, even disabling, they don’t kill. In a health-care system strapped for money, that is excuse enough for inaction.

All of which is a shame. This is one of those problems we could fix. All it takes is some cash, and a little compassion.

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