“We’re seeing excellent outcomes and a huge improvement in the quality of life of our patients who have participated in this programme,” according to Mr Alan Walsh, Consultant Orthopaedic Surgeon, speaking about the HSE National Osteoarthritis (OA) Hip and Knee Pathway which has had a life-changing impact on patients, improving their mobility and quality of life. Piloted in Navan and Waterford, the Hip and Knee Pathway has already served over 1,700 people suffering with osteoarthritis.

Mr Walsh explained that “previously, many people were referred straight to an orthopaedic clinic. But not everyone needs to see an orthopaedic surgeon or have surgery. In fact, most people can manage their osteoarthritis through education, exercise and weight management. This is about making sure people get the right care, in the right place, at the right time with the right person.”

Osteoarthritis is one of the most common causes of pain and disability in Ireland. It leads to joint stiffness, reduced mobility, weight gain and for many people, time-off from work. Until recently, treatment options were often limited to medications or surgery.

However, as a result of a service re-design approach from the HSE National Clinical Programme for Trauma and Orthopaedic Surgery (NCPTOS), in partnership with the HSE’s Modernised Care Pathways and Sláintecare Integration Innovation Fund, patients with hip and knee OA are now getting quicker access to more effective, patient-centred care.

Under the pilot pathway, patients referred by their GP are assessed by a clinical specialist physiotherapist in the community setting. They are offered a tailored programme of exercise, lifestyle advice, particularly around healthy eating by the dietitian, and education on managing their condition.  Only those who need to see an orthopaedic consultant are referred to the hospital for an appointment.

Between April 2023 and February 2025, 1,734 referrals were received through the pathway. Of these, only 3.4% of patients needed an outpatient appointment, and less than 1% required surgery.

According to Mr Finbarr Condon, Joint Clinical Lead, this is a “win-win for both patients and the health system. It means we’re freeing up hospital consultants to see the patients who really need them, while also helping people improve their quality of life without the risks or delays that come with surgery. People are staying active, staying independent and staying out of unnecessary surgery.”

A key part of the pathway is empowering patients to take control of their own care. To support this, a new digital app has been developed that allows patients to access exercise videos, monitor their progress, and even request a follow-up review through a patient-initiated review (PIR) feature.

Launched at the participating sites in November 2024, the app has already proven popular with patients. Developed for less than half the original budget, the app has delivered major value by extending care beyond clinic walls.

“Having the app at home helped keep me motivated,” explained Mary, a patient who has benefitted from it’s use. “I could see my progress and know I was doing something positive every day.”

With funding provided through the Sláintecare Integration Innovation Fund, the pilot programme has been able to test the full end-to-end model of care, from GP referral, to physiotherapy-led treatment, to digital follow-up. The total cost to date, including app development, has been €757,000, well below the original budget of €1.17 million.

Mr Condon  believes the success of the pilot shows what’s possible when services are designed around patient needs: “This pathway reflects what Sláintecare is all about - integrated care, earlier interventions and better use of resources.”

Feedback from patients has been very positive to date. One participant thought that “this programme should be available to everybody. It was so beneficial to me. I think everyone right around the country should have access.”

Another explained that their “knee used to be so stiff and it just took the stiffness right out. I can move it now – no worries at all.”

A further patient outlined how they are “active again. I’m out, I’m walking – I’m doing the exercises every other day - especially to music, I love doing the exercises to music.”

With demand for orthopaedic services expected to rise in the coming years, there is strong support for rolling the Hip and Knee OA Pathway out nationwide. The pathway also serves as a model for other musculoskeletal conditions that could benefit from similar approaches.

“This is population health in action,” explains Mr Tom McCarthy, Joint Clinical Lead. “We’re using evidence, data and clinical leadership to redesign how we deliver care. And the results speak for themselves.”