As waiting lists for joint surgery in NL approach four years, orthopedists propose out-of-the-box solution

Patients waiting for hip and knee replacement surgery in Newfoundland and Labrador are facing delays approaching four years, with surgeons warning the backlog could more than double by 2030.

Dr. William Moores, chief of orthopedics for Newfoundland and Labrador Health Services’ Eastern Urban Zone, said the consequences go well beyond living with pain.

“It affects all aspects of patients’ lives, really,” he said.

“Patients who wait well beyond established benchmarks for joint replacement surgery can experience poorer outcomes following their procedures.”

Some are unable to work, while others struggle to spend time with their grandchildren, travel or take part in activities they once enjoyed.

For Moores, one of the hardest parts is telling patients that surgery could improve their lives, only to explain how much longer they may have to wait.

“We can offer them hope that we can make them better, but unfortunately, then the next question is, when is this going to happen?”

On Oct. 20, orthopedic surgeons in the Eastern Urban Zone issued a public call for a dedicated surgical centre to address the growing backlog.

About 2,800 patients are currently waiting for hip or knee replacement surgery — a figure projected to reach 6,100 by 2030.

Patients wait approximately 18 months to see an orthopedic surgeon, followed by an average of more than two years between the decision to operate and surgery.

Moores said the problem has been building for close to a decade, largely because of an ageing population and hospital resources that have not kept pace with demand.

The COVID-19 pandemic added to the delays, but he said the issue was already becoming apparent years earlier.

The Eastern Urban Zone facilities — including St. Clare’s Mercy Hospital and the Health Sciences Centre — can perform approximately 1,000 joint replacements annually.

Moores said his team has spent years trying to increase capacity, including introducing same-day surgeries for suitable patients and expanding procedures to Carbonear and St. Anthony.

Approximately 400 joint replacements are now performed annually through the Carbonear initiative, with another 120 in St. Anthony.

But those efforts have reached their limits.

“We’ve tried all the things within the current definition of available OR resources,” he said.

“And unfortunately, we’ve maxed them out, and we are still not making the headway that we need to be.”

“You get yourself all psyched up and get everything organized, and then all of a sudden, it’s not getting done,” said Amy Hollett, whose bilateral knee replacement surgery was cancelled just days before she was due to have the operation.

The 50-year-old had been dealing with knee problems for about a decade and first sought medical help around nine years ago.

She was initially told she was too young for surgery.

When she saw a surgeon in Gander in December 2024, she was advised to wait until she was closer to 50.

Hollett was eventually scheduled to have both knees replaced on Oct. 19 and had made arrangements for her recovery.

Her partner booked a week off work, her mother and aunt agreed to help with her child’s activities, and her daughter, a nurse in St. John’s, arranged family leave to come home.

But just days before the operation, Hollett received a phone call informing her that the surgery had been cancelled because of staffing issues, she said.

“I thought they were going to give me my pre-op instructions,” she recalled.

Instead, she was told the operation would not be going ahead.

“It’s like the bottom dropped out of it,” Hollett said.

As a former nurse, Hollett understood the risks involved in surgery and had spent weeks preparing herself mentally.

“You kind of work yourself into it, you get to the point, you’re there, and then you’ve got to mentally get yourself psyched up for it, and then it just drops. It’s gone,” she said.

The cancellation has left Hollett trying to reorganize the support she had in place.

Her partner, who works as a hunting guide, can no longer take a week off in November.

Her 79-year-old mother and 70-year-old aunt will now have to provide much of the help, while her daughter is unsure whether she can secure leave again.

Meanwhile, Hollett continues to struggle with everyday activities, including climbing stairs and walking her new puppy around the driveway.

Hollett said the pain became so difficult to manage that she had to give up her nursing career and retire early.

“As long as I’m doing nothing, literally nothing, I’m okay because I’m not moving,” she said.

Hollett has been told she should be among the first patients scheduled for surgery in November but has yet to receive a date.

“So now I’ve got to go through all that and psych myself up for this again,” she said.

“I would have sold my house to do it, I was in such pain,” said Rick Brown, recalling his decision to travel to Montreal for hip replacement surgery about 16 years ago.

Brown, now 72, was working as a marine engineer when the pain became so severe that he struggled to get around.

Even a trip to the supermarket had become difficult, with Brown struggling to walk around the aisles because of the pain.

“If I was going to go to the supermarket, I’d have to grab a cart and I would hold myself up,” he said.

After waiting more than a year to see an orthopedic surgeon in Newfoundland and Labrador, Brown was told he could be facing another couple of years before surgery.

He had already reached the point where his wife was helping him get dressed and the pain was making it difficult to work aboard ships.

Unable to face another lengthy wait, Brown began researching other options and found Dr. John Antoniou, an orthopedic surgeon in Montreal.

He travelled there for a consultation in March 2010 and underwent surgery that May, paying privately for the procedure and his travel expenses.

“I walked out of the hospital on a Monday with a crutch, and I was back to work in August,” he said.

Brown later received about $2,500 in reimbursement after contacting the provincial government about his expenses.

His experience was so positive that he has since encouraged several friends and relatives to explore surgery in Montreal, including his brother-in-law, who had both hips replaced.

But Brown recognizes that not everyone can afford to travel for treatment.

He believes the province should consider helping patients access surgery elsewhere when it cannot be provided within a reasonable time at home.

Sixteen years later, Brown continues to work for part of the year and has travelled extensively since his operation.

He said he would not have been able to enjoy those experiences without regaining his mobility.

“They just see it as numbers, but you’ve got to look beyond what those numbers mean to the people who are waiting,” he said.

“Every day that you’re wasting suffering is a day that your life is not going right.”

“If I drop something on the floor, my 89-year-old mother will say, ‘Karen, I’ll pick it up,'” said Karen Pinsent, who has been waiting almost three years for a hip replacement in central Newfoundland.

“Getting in and out of my car, it hurts,” she said. “I can’t sit for long, not even to eat supper at the table.”

Pinsent was diagnosed with osteoarthritis and underwent bilateral knee replacement surgery in Gander in 2013, just three months after seeing a surgeon.

But when she began seeking treatment for her hip in spring 2023, the experience was very different.

She eventually saw an orthopedic surgeon in February 2025, who confirmed she needed a hip replacement.

“So I said, ‘Well, we’re really moving along now,'” she recalled.

But the progress stalled.

“So I waited, and I waited, and I waited.”

Her pre-operative appointments were completed by April 2026, but she has yet to receive a surgery date.

Each month, Pinsent calls the booking office to see whether she has made the next month’s surgical list.

The answer, she said, is always no, with staffing shortages, bed availability and other scheduling issues among the reasons given.

“I know there’s people that are on the list probably worse than me,” she said. “My heart goes out to them.”

After 34 years working in health care, including a decade in management, Pinsent understands the pressures hospitals face.

“I understand completely how things work and what happens behind the scenes, and there’s circumstances that we can’t control,” she said.

“But is there a better way?”

Retirement was supposed to give her more time for travelling, walking and quilting.

“I’m a quilter, and sitting for long periods of time at the table quilting, I can’t do it,” she said.

She still attends aquafit classes under the guidance of her physiotherapist, finding some relief from moving in the water.

But travelling has become difficult, and visits to the family cabin now require adjustments to furniture and seating to accommodate her hip.

“My husband said he’s not travelling with me anymore until I get my hip replaced, because it’s a challenge,” she said.

“Am I one month, six months or a year away? If they could give me some sort of idea.”

With both her and her husband retired, Pinsent said she would be willing to travel elsewhere in the province for surgery if it meant a shorter wait.

She has also considered going outside Canada, although the cost would be a barrier.

More than anything, she wants patients to have a clearer idea of where they stand once their pre-operative assessments are complete.

“A little bit more honesty with where you’re on the waitlist… I would really like to see the times reduced,” she said.

“When I think about when I had my knee surgery, I was three months, and then all of a sudden, fast forward to where I am at now … what’s going on?”

Surgeons are now asking the provincial government to support a six-month pilot involving 200 joint replacement procedures outside the traditional hospital setting.

Moores said an existing facility could accommodate the pilot, which would test whether the approach could deliver surgery safely and efficiently.

If successful, the team hopes to establish a purpose-built centre in 2027 capable of performing approximately 2,000 joint replacements annually.

Similar facilities are already operating in other provinces, including Ontario.

“We’re not trying to reinvent the wheel,” Moores said. “This has been done in multiple other provinces.”

He said the proposal comes after years of trying to improve access within existing hospitals, rather than any single incident prompting the surgeons to speak publicly.

Meanwhile, patients continue to face the consequences of prolonged waits, including declining mobility, increasing pain medication and, in some cases, poorer health by the time surgery becomes available.

“I think the solution is there,” he said.

“Being first is risky, but being last is more risky.”