OBJECTIVES: Osteoarthritis (OA) and the demand for OA care are increasing with the aging population. Policy-makers seek to identify policies to sustainably manage this growing demand, yet envisioning the short- and long-term effects of policy options is difficult within chronic care. We aimed to develop a decision-support tool enabling policy-makers to explore policies and their effects. METHODS: We developed a system dynamics (SD) simulation of patient flow across the continuum of OA care in Alberta: from self-directed to primary and specialist care, through surgical interventions, post-surgical follow-up and subsequent re-operations. The simulation was developed using SD modeling principles and an iterative, integrated knowledge translation process, including multiple workshops with clinicians and administrators to define the problem, system boundaries and current patient flow. The resulting simulation was populated with data extracted from administrative databases (e.g. physician claims, inpatient records). RESULTS: The model yields patient population, OA care resource requirements and associated cost results at each stage of care over 10 years by region and patient characteristics (e.g. sex). If current practices continue, annual hip and knee replacement surgery volumes are estimated to increase by more than 5,000 between 2015 and 2025. If a 14 week surgical wait-time is implemented in 2015, 600 additional surgeries must be performed in the first year to “catch-up” on the existing surgical queue, yet long-term surgery rates are similar to those without the wait-time target. The costs of the additional surgeries are partly offset by the savings achieved by fewer patients requiring care while awaiting surgery. CONCLUSIONS: This simulation can be used as a decision-support tool to estimate changes in patient populations, resource requirements and costs over time that may result from various OA management scenarios. Such results can equip policy makers with additional evidence to make more informed OA care policy decisions.