New smartphone application could reduce knee and hip surgery wait lists for Nova Scotians

Heather Brimicombe
Published on April 24, 2014

Valerie Nash knows the pain of waiting for a joint replacement. A doctor in Halifax is working on an innovative way to reduce wait time. 

©Heather Brimicombe - TC Media


With an unbearable pain wearing away her knees, Valerie Nash  found it hard to stand, let alone walk very far without bone-grinding agony.

The Pictou County woman received her knee replacement surgery within six months of the first discussion with her doctor. Not everyone with such pain is quite as lucky though.

Bone-on-bone is the term used for those who no longer have cartilage between bones in a joint. Their bones are grinding against each other with every step they take. Incredibly painful, this type of knee or hip problem calls for emergency surgery. Patients are fast-tracked to an emergency list and get surgery within a few months.

Everyone else with a tiny bit of cartilage is left waiting, with great pain, for up to two years or more.

Doctors in Nova Scotia are finding it hard to keep up with the need for knee and hip replacements, without causing a long wait list for patients who are waiting for surgery, or post surgery check-ups.

Dr. Michael Dunbar, a surgeon at the Queen Elizabeth II Hospital, and a professor in biomedical engineering at Dalhousie University, is working on putting a stop to long wait times for surgery patients with a smartphone app.

“Probably six months, I got in really quickly,” said Nash, “most of the ones I know waited at least two years.”

Nash was one of the few put on the emergency list because of the severity of her condition.

“It had worn down to the point where it was bone on bone,” said Nash. After the first surgery, Nash was put on the emergency list a second time for her other knee, which was just as worn.

Dunbar has been working on an app that can use the accelerometer in smartphones to analyze the gait of a patient.

“It can measure the centre of mass displacement, very accurately” said Dunbar, “The accelerometers are pretty simple and pretty powerful.”

Patients would get a text message or phone call from the doctor telling them that it is almost time for a checkup and to strap their phone on and go for a walk within the next week or so.

“It’s going to be hard for this not to be more accurate than what we’re doing already,” said Dunbar. “What were using now is just a two-dimensional X-ray which is very blunt, and is just a picture of you laying down, and has nothing to do with you walking around and how you get around in space.”

The app works by strapping your phone on to the patient’s back or hip and simply going for a walk in their own neighbourhood. The results would be shared with the doctor for analysis and a follow-up phone call or message about how the patient is healing.

“Turns out the majority of people are fine,” said Dunbar about the patients he sees currently for post-surgery appointments.

With patients coming to see him and other surgeons in Halifax from HRM and surrounding areas, as well as all the way from Newfoundland, it is a bigger hassle for some people to see him.

Currently the average wait time for a knee surgery in Pictou County is 254 days, with a follow-up appointment being squeezed into that schedule.

This app would affect more than just HRM wait times though. Dunbar has bigger plans for the app, hoping that other surgeons in the province, country, and maybe even worldwide, will catch on to this time-effective option.

Dunbar would like to see the app be included as part of your hospital stay, with no requirements to purchase it, but rather have the price tag for each download paid by hospitals or the government.

“Because ultimately, it is going to save a lot of money – I think to the health care system, and to the patients, and so, by the hospital paying for it, the government paying for it up front, it would save a lot of money on the back end,” said Dunbar.

The app is still some time away from being released as Dunbar and a team of specialists completes the app. At the moment the app itself is written, but is still being analyzed for how to ensure the best usage and outcome from the use of the application.

“You got to do it right,” said Dunbar, “this is serious stuff here.”