Outpatient surgery boosts hip, knee replacements

WINNIPEG — Despite an 80 per cent increase in hip and knee replacements done annually in Manitoba over the past decade, too many patients have to wait too long to get one, says the surgeon leading the charge to solve the problem.

A record 7,056 joint replacement procedures were completed across the province in 2025. In 2016, there were 3,933.

Shared Health provincial surgery specialty lead Dr. Ed Buchel said the boom in hip and knee replacements is thanks in part to outpatient surgeries that have ramped up exponentially.

“Out of all the cases that were done in 2016, there were four. Not even one per cent of cases were done as outpatient,” said Buchel.“We’re at 64.9 per cent in the last calendar year.”

The most recent data from the Canadian Institute for Health Information shows 54 per cent of hips and knees were done on an outpatient basis nationally, he said.

“If you look at just December of 2025, 73.7 per cent of the cases done in our province were done as outpatient. That is by far the highest number in all of Canada,” he said.

A protocol for outpatient surgery was developed with allied health-care professionals, including physiotherapists and occupational therapists, to help patients in the recovery room immediately after surgery, ensuring they are stable, can get up and walk.

“Better pain control, better anesthesia, more precise surgery — all of that was done so we could limit our bed use,” said Buchel, who called in-patient beds the health-care system’s “most precious resource.”

“We need to use those beds to take people out of the emergency room, to make sure that people with respiratory virus problems over this last respiratory virus season had a place to stay.”

The Manitoba Association of Health Care Professionals said its members are essential to pre- and post-operative success of hip and knee replacements.

“Government added positions in these areas in 2023 to help with patient discharge specifically, but more allied health professionals can also mean more surgical assessments and more successful post-op rehab,” president Jason Linklater said in an email Friday.

“Unfortunately, we are still seeing persistently high staffing shortages and wait times in diagnostics, which are also essential for surgeries to happen. Wait times for MRI and CT scans are at their highest levels since the pandemic. There is limited capacity and growing demand for these tests. If hip and knee patients are being prioritized, that could mean longer wait times for everyone else.”

The province announced Wednesday that 2025 was a record year for hip and knee replacements. It pointed to national CIHI data showing an overall increase in surgeries.

In 2024, 26 per cent more hip replacement surgeries were performed in Canada than in 2019. Despite the increase, only 68 per cent of patients received the procedure within the recommended six months, CIHI said. It reported a similar pattern for knee replacements.

“That’s what we’re working on now,” Buchel said, referring to the six-month target. “We are working through the logistics on how we’re going to do that, because that’s another bump of about 800 cases per year.”

In 2024, the province set up a new surgical program at Selkirk Regional Health Centre with added staff and expanded operating-room capacity to perform 800 additional hip and knew replacements a year. As of December, 591 joint replacement surgeries were completed there, and health officials expect to hit the target of 800 procedures by the end of the fiscal year.

Buchel said there’s an examination underway looking for efficiencies in the system and where and how additional surgeries — at Concordia Hospital or Boundary Trails Health Centre, for example — could be done.

“Where is your redundant capacity? Maybe it’s in other types of surgery that we could use that capacity,” he said. “We need to recruit more orthopedic surgeons to Brandon. If we can recruit, we’re looking at 150 to 200 extra cases in Brandon. Health Sciences Centre — we’re recruiting more trauma surgeons. Some of those trauma surgeons also have the capacity and the skill set and the training to do (joint replacements).

“We say, ‘OK, can you step away from your trauma (work) and deliver a day a week or two days a week?’”

» Winnipeg Free Press

The province is not looking to private surgical facilities in order to reach the six-month target, Buchel said.

“My responsibility, fiscally and ethically, is to make sure that the public system runs to its maximum efficiency and maximum capacity.”

He said quality has not been compromised.

“The biggest concern that people have when we do capacity and volume increases is that our quality is decreasing. Everything says that our quality is as good as it’s ever been.”

He said Manitoba’s rate for revisions — complex procedures to replace, repair or adjust a previously implanted artificial joint that has failed due to loosening, infection, wear-and-tear or instability — is 6.4 per cent.

“That means when you get a hip or knee, you know you’re getting quality because we do not have a high complication and revision rate,” he said.

» Winnipeg Free Press