Cornwall Ontario — Arthritic hip and knee pain is very common among older adults and must be managed appropriately. This sentiment is echoed in the basement office of Madeleine MacDonell, Physiotherapist, at the Cornwall Community Hospital. MacDonell is the assessor for the Total Joint Assessment Clinic (TJAC) of the Champlain Local Health Integration Network (LHIN), the Hip and Knee Replacement Program (HKRP), and the Pre-habilitation Program located at the Second Street Site.
Physiotherapists are very well trained in orthopedic assessments and assessors in TJAC, having received further training by orthopaedic surgeons to assess who are appropriate candidates for total joint replacement surgery. Recently, qualifications for physiotherapists have risen. It is now mandatory for anyone who wishes to become a physiotherapist to obtain their Master’s degree at one of the fourteen accredited schools in Canada.
Referred directly by family physicians, patients are seen by an assessor within a couple of weeks. MacDonell assesses patients with hip and knee pain and determines if they are potential candidates for total joint replacement surgery. This decision is based on their symptoms, their functional status, and X-Rays of the particular joint; age, lifestyle, health status and previously tried treatment are also considered when deciding what the best path is for optimum quality of life. Surgery should only be considered when all other conservative management strategies have failed.
The assessor provides the patient with information regarding the surgery and conservative management and helps the patient choose the best option for them. “Our goal is to educate patients so they can make an informed decision on what the next step for them should be,” said MacDonell. “We want people to feel confident when they leave the clinic by arming them with the knowledge required to focus on their goals and achieve a better quality of life. That’s what it’s all about.”
Only patients who are surgical candidates and who want surgery are offered a surgical consult. This helps maximize the surgeon’s time and helps reduce the wait time for those who need the surgery. “Patients who do qualify for an operation can choose a specific surgeon or location or can choose to see the next available surgeon within the region in which case the process will be much faster,” explains MacDonell. Although generally very successful, total joint replacement surgery is an invasive procedure with certain risks which must be considered. MacDonell explains that there are other alternative options such as physiotherapy, use of a gait aid (cane or walker), exercise programs, weight loss, medications and injections which are sometimes most appropriate for the patient, especially in the earlier and mid stages of arthritis.
The patient is ultimately responsible for the decisions made regarding their treatment from conservative management to surgery; they play the key role post op. “Because the artificial knee and hip joints last approximately 15 years on average, it is important to optimize all factors to improve the longevity of the joint: reduce excessive strain, maintain a healthy weight, exercise. Younger patients are often encouraged to postpone surgery as long as possible in order to avoid having to revise the joint replacement at a later date.”
Before TJAC came to Cornwall in 2010, a trial was conducted at Queensway Carleton Hospital where decreased length of stays and improved wait times were discovered. Locally, it has been a success as well, with results being shorter wait times within the region, which allows those who are suffering to get their surgeries much quicker.
The need for joint replacements continues to grow. Last year the total number of referrals in the Champlain LHIN was close to 5000, with 300 of these from the Cornwall Community Hospital assessment centre.