title: The journey to total hip or knee replacement.
abstract: OBJECTIVE
  Despite the incidence of joint replacements in Australia, there is a paucity of information regarding how patients progress from their referral to their surgery. The aim of this study was to describe a patient pathway from referral to receipt of total hip replacement (THR) or total knee replacement (TKR) surgery in South Australian public hospitals.
  
  
  METHODS
  Patient perspectives of the pathway to THR and TKR surgery were obtained via a postal survey (n=450) and hospital employee perspectives were attained via semi-structured interviews (n=19). Survey data were analysed using descriptive statistics and interview data were analysed thematically.
  
  
  RESULTS
  A typical patient pathway to THR and TKR surgery can be divided into two distinct phases; referral-to-initial appointment (9-24 months), and initial appointment-to-surgery (12-15 months). This gives an overall waiting period between 2 and 3 years for THR or TKR surgery.
  
  
  CONCLUSIONS
  Waiting times for THR and TKR surgery reported in this study were longer than other reports in the literature. Current Australian health policy does not consider the first (and longest) phase of the patient pathway. Excluding this initial phase could be generating an erroneous perception of the patient pathway to THR or TKR surgery, possibly leading to poorly considered health reforms.
authors.affiliation: Division of Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000, Australia. julie.walters@unisa.edu.au
authors.forename: Julie Lynette
authors.initials: JL
authors.lastname: Walters
authors.forename: Shylie
authors.initials: S
authors.lastname: Mackintosh
authors.forename: Lorraine
authors.initials: L
authors.lastname: Sheppard
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D001291:Attitude of Health Personnel; D019091:Critical Pathways / Q000458:organization & administration; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006779:Hospitals, Public / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017060:Patient Satisfaction; D013021:South Australia; D013997:Time Factors; D014850:Waiting Lists