Orthopedic surgery delays lead to all-time high in backlog of patients, experts say

In April of 2022, Christine Albo, a resident of Trail, B.C., was in “excruciating pain.”

Her hip had been bothering her for the previous few years without any known cause, but she suddenly was not able to walk, exercise, or even sleep.

• 'It was that or go home and prepare to die': Canadians on why they sought surgery outside the country

“I couldn’t do anything,” she told CTVNews.ca during a phone interview. “I was in a hell of a lot of pain.”

After reporting the problem to her general practitioner, Albo had to wait two months to see an orthopedic surgeon.

Eventually, it was determined that Albo needed a hip replacement, and that she would need to wait a minimum of two years for surgery.

“I can’t even explain the pain,” Albo said. “It was absolutely horrific.”

Such a delay is part of a larger trend.

The Canadian Orthopedic Association (COA) estimates that there are approximately 130,000 people in Canada waiting for an orthopedic operation.

According to a March 2023 report by the Canadian Institute for Health Information, hospitals throughout the country have been playing catch-up since the early days of the pandemic.

During the first 31 months of the global health crisis, 14 per cent fewer surgeries were performed in Canada compared with before COVID-19, the report said. Dr. Pierre Guy, president of the COA, says waitlists for orthopedic surgeries in Canada are only getting longer.

“Even before the pandemic, patients with orthopedic problems were on waitlists,” he told CTVNews.ca, during a phone interview.

Guy explained that waitlists that were in place long before the COVID-19 restrictions were already contributing to a backlog of patients needing surgery. The consequence of only doing urgent surgeries throughout the previous few years, he said, “is that in addition to the people who were delayed previously, we’ve added on all these other folks who never got an operation.”

POORER SURGICAL OUTCOMES

One problem, Guy explained, is the worsened condition of patients who aren’t being treated.

“It’s important to understand that orthopedic patients come in a wide range,” he said. “There’s young patients, there’s middle-aged patients, there’s older patients. For a lot of their conditions, a delay [in surgery] means there’s a progression of the disease [or impediment]. So it makes the operation more difficult or complex.”

This, he said, could lead to worse results after surgery is received.

“So what we knew would be the solution in surgical treatment has worse results because it’s been delayed,” he explained.

This is especially the case for children, Guy said.

“For children, if you have delay in your surgery, you could actually cause a developmental delay.”

FINANCIAL CONCERNS

On top of poorer surgical outcomes, Guy says it can be expensive for patients to manage pain while waiting long periods of time for surgery.

“A lot of people who need orthopedic surgery have pain,” he said. “And when they have pain it means that they can’t get back to work or they can’t earn a living. Nowadays, if you compound that to inflation, complications with paying your mortgage or just having your regular expenses paid up could be very difficult and very stressful.”

Albo, who works as a realtor, was sometimes in too much pain to work as her hip condition worsened.

Last year, she paid for a private MRI scan, because, she says, she “couldn’t get in for an MRI in Canada for months and months and months.”

Adding to her list of expenses, Albo had to fork out $500 for a shot of hyaluronic acid, a substance that helps lubricate joints, to see if it would alleviate the pain. It didn’t.

“I had the shot but it only lasted about two weeks,” she said.

With wait times longer and pain difficult to bear, a third problem in orthopedic surgery delays is plaguing Canadians.

NARCOTICS AND PAIN MANAGEMENT

Given the ongoing opioid crisis, Guy says there is a heightened awareness about the possible negative effects of orthopedic surgeons prescribing pain medications, such as addiction.

“But when patients are in so much pain, that’s not good for them, and so we have to use narcotics,” he said.

“What’s changed is that people are having more conversations about narcotics and assessing the risks. Some people are reluctant to take narcotics because they don’t want to get addicted.”

Albo, for instance, said that her general practitioner initially prescribed Celebrex, an anti-inflammatory drug that typically treats arthritis, to manage her hip pain. When those weren’t working, she was offered hydrocodone, a strong pain management opioid.

“My GP wanted to give me super strong medications to get through my day for the next two years,” Albo remembers. “I said I would rather be in pain than take something like that.”

Guy explained that narcotic pain management is not meant for long delays in surgery.

“Pain medication is when we manage the treatments but that doesn’t treat the problem,” he said. “They may require a cane or a walker. They might need to use a brace. But that doesn’t solve the issue. So we’re clear, this is a strategy for when you’re waiting.”

SURGERY BEYOND BORDERS

In November of 2022, Albo decided to see surgery overseas, after finding a clinic in Lithuania called Nordorthopedics, in Lithuania.

“I checked out their website, read a ton of reviews, joined a Nordorthopedic patient group. And I did my homework and really, really checked them out.”

Enduring the pain in her hip, and confronting her impossible wait time for a surgery in Canada, Albo felt that she had no choice but to pay $15,000 to receive the surgery in Lithuania.

She says she’s glad she did.

“After my surgery I went to my [hotel] room and had to wait for the spinal to wear off,” she said. “It took about four to five hours. As soon as the spinal wore off, I was up and walking.”

She was not prescribed opioid painkillers, she said.

After the surgery, as the night progressed, it was getting a little bit painful, she explained. She was given 600 milligrams of Tylenol.

“By day three, I was on nothing,’ she remembers. “I was walking with crutches.”

Now, Albo is back to normal, capable of playing golf, exercising and continuing her work.

SYSTEMIC SOLUTIONS

Given that most Canadians can’t afford to travel outside the country for medical procedure, Guy says there should be fundamental regulatory changes in Canada’s health-care facilities to reduce these wait times.

“For example, in B.C., there’s no physician assistants,” he said. “They’re not allowed, essentially. Being open to these types of practitioners would be an option.”

He added that fast-tracking the recruitment process -- without cutting corners -- for medical graduates from nursing schools and medical schools would also be an option for increasing orthopedic capacity.

“We also have lots of people who’ve immigrated to Canada who have this training but the regulatory process is fairly slow,” he said.

Guy said that without changes, the problem with waitlists is “not going to get smaller.”