Orthopedic Assessment Clinic (OAC) teams drive shorter wait times and better outcomes for joint replacement patients

When the orthopedic surgery team at Dartmouth General Hospital (DGH) broke an Atlantic Canada record for hip replacements this December, orthopedic assessment clinic (OAC) teams were among those credited for making this accomplishment possible.  

Now, with a second high-volume joint replacement day under their belts last week, and the DGH team already aiming to break their own record, OAC teams continue to set themselves and their patients up for success.

Nova Scotia Health’s OACs are a key point of contact for patients who may need a hip or knee joint replacement. They help manage all referrals to support timely initial assessments and connect patients with the non-surgical or surgical options best for them.

For those needing surgery, OACs deliver exercise (prehabilitation) and education programs to get patients ready for their joint replacement, along with the follow-up care needed along their path to recovery. 

The care model has made a meaningful difference for patients like Eve Williams. A lifelong walker and swimmer, Eve developed arthritis and eventually required joint replacement surgery. She underwent her third surgery in June, a knee replacement, after previously having both hips replaced.

Eve completed her orthopedic assessment and prehabilitation at the Bayers Lake Community Outpatient Centre before having surgery at DGH. She credits the prehabilitation program with helping her feel physically and mentally ready for surgery. 

“By the fifth session I could feel my muscles getting stronger and I felt better prepared to undergo surgery. It was amazing how much doing some of the work before surgery made an impact on my recovery afterwards.”  

Orthopedic assessment clinics use an interdisciplinary wellness model, bringing together care providers such as physiotherapists, occupational therapists, physician assistants, dietitians, clerical staff, rehabilitation assistants, social workers, nurses, kinesiologists and surgeons to improve continuity of care for patients.  

“Improving access to orthopedic care is a top priority under Nova Scotia’s surgical strategy,” says Alissa Decker, director of Neurosciences, Orthopedics and Spine Care with Nova Scotia Health’s Central Zone. “Our orthopedic assessment clinics are a clear example of how team-based innovation improves access and outcomes—not only are patients being seen faster, but they’re also receiving care that’s better matched to their needs.” 

Throughout her surgical journey, Eve says the co-ordination of her care team stood out. 

“It was good to have the support and expertise of the whole care team. I experienced nothing but kindness, respect, and a little firmness throughout all three replacements. And, as someone who is hard of hearing, my care team made sure I understood what I was being told and that I was ready for surgery and able to go home safely.” 

The impact of OAC teams is reflected in a 2025 Canadian Institute of Health Information (CIHI) report that ranked Nova Scotia third in Canada for hip replacements and knee replacements completed within national benchmarks. Nova Scotia was the only province to rank in the top three for the percentage of hip replacements, knee replacements, and cataract surgeries completed within the national benchmark. 

Nova Scotia had never previously achieved this distinction, and other than British Columbia, was the only province to do so in the past five years.

Last year, the clinics had about 40,000 patient visits, contributing to more than 4,800 hip and knee joint replacement surgeries -- about 300 more than the previous year.  

OAC teams have also driven an increase in same day surgeries. Before COVID-19 (2019-2020), just 85 patients had outpatient joint replacements, all within Halifax and Dartmouth. These numbers have been climbing each year and reached nearly 1,400 cases in 2024-2025, with outpatient joint replacements occurring in all health regions. 

“From clinic to operating room, we’re building a more responsive, efficient, and patient-centred orthopedic system,” says Dr. Brendan O’Neill, DGH site lead, orthopedic surgery and orthopedic surgeon. “It’s not just about more surgeries—it’s about better care, from start to finish.” 

Patients can be referred to an OAC through their primary care provider. 

Read more orthopedic care and Orthopedic Assessment Clinics:           

• CIHI Report shows encouraging progress in surgical wait times in Nova Scotia
• Dartmouth General Hospital team sets Atlantic Canada joint replacement record
• QEII Health Sciences Centre second hospital in Canada to receive orthopedic surgical robot
• Northern Zone Orthopedic Assessment Clinic (OAC) celebrates official opening
• Successful pilot of orthopedic physician assistants leads to permanent roles and expansion of innovation to other Nova Scotia Health services

Photos (1) Eve Williams, joint replacement patient and (2) members of the Halifax Orthopedic Assessment Clinic & Pre-Habilitation Program at the Bayers Lake Community Outpatient Centre rehabilitation gym (L-R): Sophie Flanagan, clinical dietitian; Caleb Godbout, program coordinator; Marshall MacNeill, physiotherapist; Nikki Phillips. physiotherapist; Michelle Bevis, rehabilitation assistant; Derek Northrup, physiotherapist; and registered nurse case managers, Michelle Biso, Kim Kane and Lori Spracklin.