A new pathway for osteoarthritis care in Ireland

The model is designed to ensure patients with hip and knee osteoarthritis receive the most suitable form of non-surgical care in the right setting at the right time

Osteoarthritis of the hip and knee is one of the most common causes of pain and disability in Ireland. It affects patients in every community and in every age group above mid-life. Demand for specialist review continues to rise and waiting lists have grown at a pace that is difficult to manage for patients and clinicians. Care models often direct patients toward orthopaedic outpatient clinics as the first step. This can lead to long delays and an over-reliance on specialist appointments that many patients do not need.

We believe that a new model can deliver better care and faster access. We also believe that it can use health service resources in a more effective way.

These ideas shaped the development of the National Osteoarthritis Hip and Knee Pathway. The RCSI HSE National Clinical Programme for Trauma and Orthopaedic Surgery designed this model in partnership with the HSE Modernised Care Pathway Programme. The goal was clear. Patients with hip and knee osteoarthritis should receive the most suitable form of non-surgical care in the right setting at the right time. This meant early access to supported self-management and community based interventions. It also meant reducing unnecessary referrals into hospital clinics.

The project was funded through the Sláintecare integration innovation fund. The test phase ran from January 2023 to June 2025 at two hospital sites (University Hospital Waterford and Our Lady’s Hospital Navan) and across several community healthcare network areas, with 67 GP practices participating.

More than 2,000 patients entered the pathway between April 2023 and May 2025. Before the pathway began, patients waited an average of 16 months for a first orthopaedic appointment in Waterford, and 27 months in Navan.

Targeted access to specialist review

The pathway introduced an integrated triage and treatment process. Physiotherapists and dietitians delivered large parts of this care. This allowed patients to receive evidence-based interventions within weeks of being referred by their GP. It also protected consultant time for patients who required specialist expertise. During the pilot, only 58 patients needed a specialist orthopaedic outpatient appointment. This represented 5.5 per cent of all patients in the pathway. Every appointment was provided within 10 weeks of referral. This met the Sláintecare access target. Of the total cohort, only 25 patients proceeded to surgery. This figure represented 2.36 per cent of all patients who entered the pathway.

These results confirm that early and structured non-surgical care can significantly reduce demand for specialist review.

Group interventions formed a central part of the pathway. A total of 1,197 patients attended physiotherapy or dietetic sessions. These sessions took place in community venues across the two regions. More than 130 group classes were delivered and each class supported between 10 and 20 participants. Over 23 per cent of patients also engaged directly with the dietitian. The feedback from participants was very positive. More than 85 per cent described their satisfaction levels as high and many commented that the group format helped them understand their condition. Many also valued the opportunity to learn self-management techniques that they could apply independently.

Measurable improvements in pain and function

Outcomes were measured throughout the project. Patient-reported outcome measures were collected in line with the Irish National Orthopaedic Register. The Oxford hip score and Oxford knee score were used across both sites. More than 72 per cent of patients recorded improvements in pain and function. These improvements reinforced earlier evidence from international systems. Structured care can deliver meaningful benefits when it is offered early. It can also delay the need for surgical intervention. Patients reported that they felt more in control of their symptoms. Clinicians reported that patients were more engaged with their own recovery. The combination produced a strong foundation for long-term management.

The pathway also delivered important financial benefits. Analysis indicated that the avoidance of 1,001 consultant outpatient appointments generated estimated savings of €220,220. Savings were also created through fewer repeat GP visits. Consultant clinics became more efficient because appointments were reserved for patients who needed specialist assessment. Physiotherapists and dietitians also worked to the top of their professional grade. The overall impact was a more effective use of staffing and clinical expertise.

Digital supports and patient-initiated review

Digital support tools played a significant role in the project. The RCSI HSE National Clinical Programme for Trauma and Orthopaedic Surgery worked with academic partners and patient representatives to develop a dedicated hip and knee pathway app. The app was designed to help patients understand their condition. It also encouraged regular activity, symptom monitoring, and adherence to personalised advice. The design aligns with the National Digital for Care Framework. Between November 2024 and August 2025, 480 patients across the test sites were invited to use the app. More than half engaged with it. These levels of engagement suggest that digital tools can support patients who are motivated to self-manage. They also suggest that digital resources can become an important part of future models of care.

Patient-initiated review was introduced in early 2024. This approach allowed patients to contact the service when they felt they needed further support. Some 16 per cent of eligible patients used this option within three months of completing the programme. This demonstrated that many patients are able to judge their own needs. It also reduced unnecessary follow-up appointments. The option gave patients more control and helped clinicians allocate time more effectively.

Patients often describe osteoarthritis as a condition that shapes their daily lives. Many feel that pain and stiffness limit their independence. The pathway helps patients understand that they can influence their symptoms. It also helps them build strength and confidence in a safe environment. These benefits can reduce fear and improve quality-of-life. The feedback from participants supports this view. Many described how supported exercise and simple education changed their outlook. Many also stated that they would recommend the programme to others who face similar challenges.

The road to wider implementation

The Sláintecare-funded phase of the project has now concluded. The service in Navan and the Meath community healthcare networks has secured permanent funding through the HSE Dublin and North East Region. This will protect early access to non-surgical osteoarthritis care in this region. Other parts of the country have begun to adopt elements of the pathway within existing resources. The clinical specialist physiotherapy posts assigned to the HSE musculoskeletal triage initiative have provided a valuable starting point. Wider implementation will require formal investment. It will also require continued collaboration across hospital and community services.

The National Clinical Programme for Trauma and Orthopaedic Surgery remains committed to the national roll-out of this pathway. Three additional musculoskeletal pathways have been designed and tested in recent years. All four pathways reflect the same principles. Patients should receive timely access to the right type of non-surgical care. Community-based interventions should be strengthened. Hospital clinics should focus on complex or specialist needs. This is the foundation of a sustainable integrated system that uses specialist expertise in a targeted way.

We believe this pathway has transformed osteoarthritis care in Ireland. It offers a proven and practical solution to long waiting times. It improves outcomes for patients. It also supports a more efficient use of resources. Our priority now is to work with health service partners to secure national implementation.

We believe this pathway has transformed osteoarthritis care in Ireland