Electronic Thesis and Dissertation Repository


Master of Science


Health and Rehabilitation Sciences


Bryant, Dianne

2nd Supervisor

Marsh, Jacquelyn



This prospective cohort study evaluated the usual care pathway for patients referred to total knee arthroplasty (TKA). We measured healthcare resource use, costs and health-related quality of life (HRQoL) over the continuum of care. We also determined the proportion of inappropriate referrals and estimated wait times for initial surgical consultation and TKA. We found that two in five patients referred to specialty care were deemed inappropriate surgical candidates. Prior to referral, few conservative treatment options were tried, and many imaging tests ordered by referring providers were unjustified. Overall, the greatest proportion of costs were borne by the patient or private insurer, with the minority incurred by the public payer. Surgery was associated with improved HRQoL. The results of this study can provide valuable guidance on the design and implementation of a new electronic referral pathway (NRP) to promote appropriate and timely referral and manage excessive wait times for TKA.