Best practice pathway for knee osteoarthritis –Implementing an advanced musculoskeletal pre-surgical triage and assessment clinic

Waiting for a total knee replacement can take years. AIHW-reported wait-times miss the hidden wait between referral and surgical review. While waiting, patients deteriorate, losing capacity for physical activity and work. Evidence from UK and Australia shows that advanced musculoskeletal physiotherapy clinics improve accurate referral to surgery and facilitate uptake of effective non-surgical knee osteoarthritis programs in the waiting period. Evidence supports translation of this research into the ACT and southern NSW catchment region.

A best-practice advanced musculoskeletal clinic will receive patients referred to surgery in the public system. The clinic, staffed by advanced practice physiotherapists and a surgeon will funnel patients to surgical consultation or to management for knee osteoarthritis through exercise, education, diet and pain management in community care.

The intervention must be a planned co-design venture between consumers and stakeholders to resolve this persistent problem. The implementation plan is grounded in knowledge translation and behaviour change frameworks. First, barriers to implementation are identified and data on current impacts are gathered. A steering group of consumers, medical and allied health providers guides the project. Working groups of consumers, general practitioners, surgeons and orthopaedic team will use “deliberative engagement” to determine how to overcome the barriers. Evaluation by a mixed-methods approach will map patient outcomes, hidden waiting times, costs and stakeholder and patient experience.

This project will improve patient outcomes by appropriately timing knee replacements for public patients and providing better chronic-care management alternatives. Research team leaders are key clinical governance decision-makers to make this sustainable.