Results from a review of a new osteoarthritis pathway for hip and knee patients shows faster access to care, improved patient outcomes and major cost savings across two pilot sites, transforming how osteoarthritis is treated in Ireland.

The National Osteoarthritis Hip and Knee Pathway was developed by the RCSI HSE National Clinical Programme for Trauma and Orthopaedic Surgery in collaboration with the HSE Modernised Care Pathway Programme.

Between April 2023 and May 2025, more than 2,000 patients were managed through the pathway. 1,059 (51%) were direct GP referrals, from 67 GP practices participating across the two pilot sites.

58 (5.5%) patients required a specialist outpatient appointment with an orthopaedic surgeon. Each of these appointments were scheduled within 10 weeks of referral in line with Sláintecare targets. Only 25 (2.36%) patients proceeded to a surgical intervention.

1,197 (58%) patients participated in group-based interventions which were facilitated by either a physiotherapist/dietitian or both within 10 weeks of referral. More than 130 group sessions and education classes were delivered in seven community-based locations across the pilot sites during the project period. Group capacity varied from 10–20 participants depending on available facilities and staffing resources. 23% of patients engaged with the dietitian for advice and support. Over 85% reported a high level of satisfaction with the group interventions.

Prior to the introduction of this model, the average time patients were waiting for a first orthopaedic appointment was 16 months at University Hospital Waterford and 27 months at Our Lady’s Hospital, Navan.

Throughout the project, Patient Reported Outcomes Measures were collected and aligned with data collected by the Irish National Orthopaedic Register. Current available data from the two sites demonstrates that when the Oxford hip score/knee score was used, more than 72% of patients reported positive changes in terms of pain reduction and improved function.

Efficient, patient-centred care

The pathway has also delivered significant financial efficiencies, generating estimated cost savings of €220,220 through the avoidance of 1,001 outpatient appointments. The reduction in repeat GP attendances, more efficient use of consultant time, and the ability for physiotherapists and dietitians to work to the top of their scope, further contributed to the project’s success.

Funded through the Department of Health’s Sláintecare Integration Innovation Fund, the pathway was tested between January 2023 and June 2025 at Our Lady’s Hospital, Navan, University Hospital Waterford and within the Community Healthcare Network regions of Carlow, Kilkenny and Meath.

In line with Sláintecare principles, the integrated care pathway focuses on providing the right care in the right place at the right time by the right team. This improves timely access for patients to the most appropriate non-surgical interventions such as physiotherapy and dietetics in a community-based setting. Patients were referred directly from their GP into the pathway as an appropriate alternative to joining an outpatient waiting list. This is the first Irish project that has a dedicated dietitian working with patients with musculoskeletal conditions.

Mr Finbarr Condon, Joint Clinical Lead for the National Clinical Programme for Trauma and Orthopaedic Surgery, said: “This pathway is delivering the right care, at the right place, at the right time. By intervening earlier and coordinating care more effectively, we’re not only improving quality of life for people living with osteoarthritis but also easing pressure on outpatient clinics and making better use of specialist expertise.”

Mr Alan Walsh, Consultant Orthopaedic Surgeon Our Lady’s Hospital, Navan and clinical advisor for the National Clinical Programme for Trauma and Orthopaedic Surgery, added: “The Sláintecare funding has been critical in making this progress possible. It gave us the resources and flexibility to trial a new way of delivering care, one that puts patients at the centre, reduces pressure on hospitals, and makes better use of the wider healthcare team.”

Greater patient support and engagement

A dedicated patient self-management patient app called Hip and Knee Pathway was developed by the National Clinical Programme for Trauma and Orthopaedic Surgery in collaboration with the HSE, universities (RCSI, University of Limerick and Trinity College Dublin), clinical experts and patient representatives. This encourages, empowers and educates patients about how to self-manage their symptoms during and after participation in the pathway. The app is aligned with the government’s Digital for Care – A Digital Health Framework for Ireland 2024–2030.

For the period November 2024 to August 2025, 480 patients on the project test sites were invited to use the app with over half (53%) actively engaging with it.

The HSE patient-initiated review process began in early 2024. This empowers patients to take greater control of when and how they want to engage with the health service. 16% of all patients who have been offered this option have contacted the service within three months of finishing the programme.

The Sláintecare funding period has now concluded. The service based at Our Lady’s Hospital Navan/Meath Community Healthcare Networks has secured permanent funding to continue to deliver early intervention to the population they serve. A number of other sites nationally have commenced implementing this pathway on a smaller scale utilising available resources such as the clinical specialist physiotherapy resource allocated to the HSE’s musculoskeletal triage initiative.

The National Clinical Programme for Trauma and Orthopaedic Surgery will continue to advocate for the national implementation of this and three additional musculoskeletal conditions specific pathway that have been developed and tested in the past three years.

The programme remains committed to advancing models of care that improve patient outcomes while ensuring the sustainable use of health resources.

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