Until the fall of 2025, total hip and knee replacement could not be performed outside of a hospital setting in B.C., due to regulations set by the College of Physicians and Surgeons of B.C. (the ‘College’) Partial knee replacements have been deemed appropriate to be done in non-hospital surgical facilities since 2002. In 2018, a trial of outpatient total knee replacements performed at WROSC was authorized by the College. In retrospect, this trial was done early-on in the evolution of joint replacement surgery, with the notion of patients being able to go home the day of surgery causing unease amongst practitioners and regulators alike. In the last 5-10 years perceptions have shifted considerably, and it is now well accepted and understood that for healthy, agile patients in a stable social environment, avoiding hospitalization after a hip or knee replacement is not only safe, but it is actually preferable, as the risk of a wide variety of complications is reduced  compared to in-hospital stay. It took until August 2025 for total hip and total knee replacement to be added to the list of procedures appropriate to be done in a non-hospital surgical facility. WROSC is currently accredited for total hip replacement, total knee replacement and partial knee replacement.

At WROSC, a supported same-day-discharge for patients receiving hip or knee replacement surgery in the hospital setting was developed, starting late 2016. Results were reported at the BC Quality Improvement Initiative, as well as at the Annual Scientific meetings of the Canadian Arthroplasty Society and the Canadian Orthopaedic Association. This program involves pre-operative education and preparation, multi-modal pain management, avoiding or minimizing the use of narcotics, strategies to minimize blood loss, avoiding the use of a tourniquet, and at-home nursing support with round-the=clock access to the nurse and surgeon. Over the years, many patients have been able to leave the hospital on the day of surgery, with universal and consistent patient satisfaction. The experience obtained over these years provides a solid basis for the hip and knee replacement program at WROSC. 

Dr. Smit’s elective hospital practice is solely focused on hip and knee replacements.  Elective surgery outside of hip and knee replacements is either referred to a surgeon who has dedicated hospital surgical time relevant to the issue at hand or is performed at WROSC. Even so, wait times for hip and knee replacements have been in the 12-15 months range since the end of the 2020 COVID-19 pandemic, with some improvement noted of late, due to provision of additional operating time. Some patients have contemplated or sought surgery abroad or, more recently, out-of-province. This undermines an important foundation of surgical practice, as continuity-of-care is a pillar in providing predictable, reliable surgical care. By and large, it is much preferable to receive local, community-based medical care, with consistent and effective follow-up, in the short, medium and long term. Nonetheless, given the current reality, traveling to receive surgical care may still be the best option in individual circumstances. Forcing patients to travel out of province for surgery for political reasons is an anomaly unbecoming to any well-balanced system of ethics and norms, and such policy cannot be considered reasonable or just. As it stands, surgery in non-hospital surgical facilities can be performed without any concerns about the source of funding if funding is provided by WCB, RCMP or similar third party, the BCMSC or a health authority, or through self-pay if out of province or not enrolled in the MSP insurance program. All of this remains in flux and likely will change over time.