Access to joint replacement surgeries

Issue: BCMJ, vol. 65, No. 6, July August 2023, Pages 195-196 Letters

I was on the wait list for hip replacement due to osteonecrosis and experienced severe pain; the relief from surgery made life worthwhile. To address the wait list, our government announced the creation of five joint replacement specialty programs throughout BC in 2018.[1] This initiative followed the results of a study at Richmond Hospital (2004–2014), which streamlined joint replacement surgery by using specialized teams operating in linked operating rooms.[2] The program standardized the equipment and procedures and enabled team members to assist each other while rooms were cleaned. Completed operations increased by 135% for the same operating room time. This resulted in significant cost savings, increased expertise, and a decrease in surgical complications.

This specialized team approach was refined by UBC’s Centre for Surgical Innovation, using four linked operating rooms, which improved efficiency at all levels and reduced the length of hospital stays. The Victoria Enhanced Recovery Arthroplasty program was recently launched to reduce postsurgical pain, shorten recovery time, and allow for same-day discharge, which could be feasible in up to 60% of patients.[3]

Since 2018, the wait list for joint replacement surgery has increased, and the five joint replacement programs in BC have not become a reality. The South Island Surgical Centre bought by the government in 2022 could have become a specialized program centre for joint replacement surgery, with four large operating rooms and surgical procedures already being funded by provincial health care. There are many such facilities available in BC.

Money spent buying buildings might be better used to pay for procedures and create community-based specialized programs in BC. Resorting to paying for patients to be treated in the US, as has happened with cancer patients, represents a failure of the health care system. The Government of Ontario has already invested in partnerships with community surgical centres, and I urge our BC government to be bold, creative, and innovative in preserving our public health care system.

BC has developed the most efficient and cost-effective system for joint replacement surgery, and it is time for our government to take action so our surgeons can treat their patients.
—Charles Ludgate, MD, OBC


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.


1.    Office of the Premier. New strategy will help more people get the surgeries they need faster. 21 March 2018. Accessed 30 May 2023.

2.    Usher S, Roberts C, Hughes K. Operating room efficiency. Health Innovation Forum.

3.    Canadian Healthcare Technology. Joint replacement pilot improves patient outcome. 2 September 2020. Accessed 30 May 2023.

Charles Ludgate, MD, OBC. Access to joint replacement surgeries. BCMJ, Vol. 65, No. 6, July, August, 2023, Page(s) 195-196 - Letters.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

Leave a Reply