Hip and Knee Replacement Across Alberta

We played a central role in embedding continuous quality improvement within surgical interventions for hip and knee osteoarthritis.


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New practice and protocols for providing hip and knee replacements proved beneficial. They improved population health and the care experience, and reduced the per capita cost of care. We set out to enlist all care practitioners in the province in integrating the new care path. Amongst a complex, changing health landscape this presented a challenge.

Problems to Solve

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  •  Extensive stakeholder collaboration
  • Integration with broad infrastructure
  • Accountability towards funding


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Initially there was limited spread of the hip and knee care path. Groups across the province reorganized under the new provincial health authority, Alberta Health Services, formed in 2008. In 2009, the care path, revised with latest evidence, was released provincially. Partnering with the Bone and Joint Health Strategic Clinicial Network, we helped bring together care teams from across the province to share experiences and generate solutions for optimizing patient care. We signed Affiliation Agreements with orthopaedic surgeons and Alberta Health Services. This allowed for ongoing collection and reporting of information for quality improvement purposes. We began providing episodic quality reports to care teams. The reports supported performance management in applying the new care path. Over the years, as research evidence and the health system evolved so to did the quality reporting.

Tangible Outputs

  • Care path
  • Order sets
  • Discharge form
  • Measurement framework
  • Teaching materials
  • Balanced scorecards
  • Continuous improvement reports
  • Patient satisfaction reports
  • Cumulative Sum charts
  • Key performance indicator reports
  • Trigger and unique lifetime identifier reports
  • Day surgery decision supports


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Marked improvements were realized across the care continuum over the last decade. Patients are better prepared through pre-operative education. Practices such as early mobilization, post-operative naseua and vomiting control, and reducing inappropriate blood transfusion improve patient outcomes and satisfaction. Patients return home sooner. The number of people readmitted to hospital after discharge is much lower and patients feel satisfied with their hospital care. The combined improvements created more bed capacity and more surgeries could be performed. Today, we continue to support our partner, the Bone and Joint Health Strategic Clinical Network, with this quality program.

Wait times for hip and knee replacements continue to be a health system challenge. Alberta’s population is growing. Many Albertans are living longer, experiencing increased rates of obesity, and choosing arthroplasty as the “gold standard”. At the same time the demand for hip and knee replacements is increasing, other surgical procedures are falling behind targets.

Additional Readings

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Hip & Knee Replacement Pilot Program

ABJHI’s internationally recognized work in raising the quality of care for bone and joint patients began with designing a hip and knee replacement care path for Alberta based on the best evidence available worldwide.