Orthopaedic surgeons Dr. Paul Wong from Michael Garron Hospital and Dr. Markku Nousiainen from Sunnybrook  outside Sunnybrook’s Holland Centre

Frequently asked questions

What is the Toronto Regional Arthroplasty Collaborative (TRAC)?

TRAC is a partnership between hospitals that utilizes additional weekend OR capacity at Sunnybrook’s Holland Centre to reduce wait times for hip and knee surgery. This collaborative approach leverages central intake and current referrals to Rapid Access Clinics to offer primary care providers and their patients faster access to surgery.

What is the Holland Centre?

As an established and designated Centre of Excellence for hip and knee arthroplasty surgery, Sunnybrook’s Holland Centre site will continue to deliver specialized, efficient and evidence-based care that it is renowned for.

It will now expand its OR to open on weekends for hip and knee arthroplasties for patients who choose to go through the TRAC system.

Orthopaedic specialists from across the partnering hospitals will perform arthroplasty surgeries at the Holland Centre.

How will it work?

Please visit the How it works page.

When will this take place?

TRAC will be operational as of April 1, 2023 as we begin to expand our operating room capacity at the Holland Centre and invite orthopaedic surgeons in from the partnering hospitals. In a phased approach, the Holland Centre will expand OR capacity on weekends, as follows:

  • Phase 1: April 2023
  • Phase 2: September 2023

By March 31, 2024, this model is expected to reduce the current Toronto Region hip and knee backlog by 25 per cent.

Why is this partnership being created?

For patients:

  • Improved (faster) access to high quality hip & knee surgical and post-operative care

For primary care physicians:

  • Faster access to hip and knee surgery
  • Simplified referral process

For surgeons:

  • Ability to meet patient care needs in a high-quality environment
  • Increased availability of OR hours and centralized access to orthopaedic resources

For hospitals:

  • Ability to free up constrained resources to meet other local priority needs (i.e. surgical backlog)
  • Deeper collaboration and sharing of best practices

For the healthcare system:

  • Maximize available resources through a demonstration/test case of a fully integrated regional model
  • Collaborate as a system to reduce Toronto Region hip and knee surgical backlog by a projected 25 per cent reduction by 2024, and is expected to reduce or potentially eliminate “long waiters” across Toronto.

Will this apply to children’s orthopaedic surgeries?

No, this partnership is specialized to cover adult arthroplasty cases only.

Do I have to pay for my assessment, my surgery, or my post-surgical care?

Patients under the Ontario Health Insurance Plan (OHIP) will have their full spectrum of care covered through OHIP, as they are accustomed to.

By opening up to hip and knee surgeries on the weekends at the Holland Centre, does that mean you will be taking away beds from other health care needs/patients?

No. The Holland Centre is a stand-alone hospital surgical site dedicated to orthopaedic surgery and care; therefore, it is different than other hospitals in that it does not have an emergency room that feeds patients to inpatient units.

The beds used for inpatient care at the Holland Centre are primarily reserved for post-op surgical patients – those patients recovering from their orthopaedic surgery – and the new weekend activity is utilizing already-available beds for this purpose with new/additional staff resourcing through TRAC.

The length of stay for most patients at the Holland Centre is typically one overnight stay, meaning beds are often available on weekends after patients are discharged from their weekday surgeries.

Weekend activity has not previously been funded; with provincial support, we have been able to move operations to 7 days a week with pre-existing hospital infrastructure and recruitment of additional staff.

Frequently-asked-questions specific to Primary Care Practitioners:

How does TRAC enable patients to be seen quicker?

TRAC is a response to a system need to offer additional surgical capacity. The additional OR capacity created at the Holland Centre is expected to see an additional 1,300+ patients per year, therefore reducing the Toronto Region wait list for hip and knee surgery by 25% annually.

How can primary care providers ensure quick access to surgery for patients?

You may refer your patients through 1) Ocean e-referral or 2) by downloading the “Rapid Access Clinic Hip and Knee Arthritis” referral form.

To ensure the shortest wait time for your patient, please select ‘next available in Toronto Region’. Your referral will get triaged to the hospital with the shortest wait time.

Alternatively, if you or your patient has a preference, you may select the Holland Centre or Michael Garron as your preferred site.

Can primary care providers refer directly to TRAC?

No, direct referrals are not available as TRAC is not a separate program. We encourage utilization of existing referral pathways (mentioned above) to ensure the shortest wait time for your patient. Patients receiving a surgeon consultation at TRAC partner hospitals (Sunnybrook or Michael Garron Hospital) will be assessed for eligibility for weekend surgery.

What X-ray views are needed?

  • Knee: AP weight bearing, lateral of knee flexed at 30 degrees, and skyline
  • Hip: AP pelvis, AP and lateral of affected hip

MRIs are not required for diagnosing hip and knee arthritis

Michael Garron hospital  Unity Health

Sinai Health  Sunnybrook hospital

Toronto Regional Arthroplasty Collaborative is a partnership between Sunnybrook’s Holland Centre, Michael Garron Hospital, Sinai Health and Unity Health.