At the bone and joint health clinic in Edmonton, a steady stream of patients makes its way through the doors.
One elderly woman moving slowly and with apparent pain, has been waiting for knee surgery through the entire pandemic.
“Yes, it is too long. I think it’s because of COVID,” her daughter said. “We’ve been waiting two years.”
Going in for yet another consultation, her mother added, “I have been living with pain; lots of pain.”
This situation is similar for a huge percentage of wait-listed Albertans who, according to the Canadian Institute for Health Information (CIHI), are waiting beyond the recommended six-months for knee surgery. For hip replacement, the number here is 41 per cent, compared to 35 per cent nationally. Hip and knee replacements are two of the most common surgical procedures in Canada, with nearly 140,000 operations a year that cost the health-care system more than $1.4 billion.
In 2019, the percentage of Albertans who got a hip replacement within the recommended period was 64 per cent. For knee replacement, it was 62 per cent. Between spring 2020 and fall of 2021, the percentage of Albertans getting joint replacement within six months had dropped from 49 per cent to just 43 per cent. The Canadian average was 51 per cent.
While the CIHI reports that operations such as cataract surgery are rebounding, wait times for joint replacements have not returned to pre-pandemic levels.
According to Alberta Health, wait times for hip and knee replacement in the province increased 15 per cent between 2015 and 2019. While Albertans left for the Cayman Islands, the U.S. or Mexico for knee or hip surgeries, the Fraser Institute reported wait times as the leading reason. The pandemic only compounded the backlog, with staffing shortages exacerbating the problem of surgical waits.
According to the Alberta Bone and Joint Health Institute (ABJHI), the backlog is also related to demographics.
“Alberta’s population is growing and experiencing increased rates of obesity. Many Albertans are living longer and are choosing arthroplasty as the ‘gold standard’,” the ABJHI team noted. “At the same time the demand for hip and knee replacements is increasing, and other surgical procedures are falling behind targets.”
In a 2014 health policy paper, the Fraser Institute said Canada’s wait time benchmark for hip and knee replacement, at 26 months, is too long.
“There currently isn’t consensus on the wait time benchmark for hip and knee replacements,” stressed the ABJHI team. “But it is important to also consider the time frame from referral to consultation with the surgeon, as well as the ready-to-treat date, where rescheduling due to family commitments or things like vacations comes into the picture.”
In their 2019 white paper prepared for AHS, 'The Osteoarthritis Crisis in Alberta', ABJHI noted the negative impact on quality of life for people enduring increasingly long wait times for elective knee and hip arthroplasty.
Meanwhile the Alberta government has looked to more privatization since 2019, when the health minister revealed plans to expand the use of private facilities for up to 80,000 more surgeries.
Those plans were delayed due to COVID-19, and in May 2021 Alberta’s budget was once more set to reduce surgical wait times and eliminate the backlog accumulated over the pandemic. However, the fourth wave in November 2021 postponed up to 15,000 surgeries province-wide, on top of 30,000 surgeries postponed over the first three waves of the pandemic.
The latest budget, announced in February 2022, came with another promise to use more chartered facilities to help clear the surgeries backlog. The government says the wait list for surgeries is currently less than 73,000 compared to 82,000 at the peak of the pandemic.
Through the Alberta Surgical Initiative, the government anticipates surgeries in charter facilities to go from 15 per cent to 30 per cent “in the coming years.”
For Albertans assigned knee and hip surgery, the wait continues.