Services
The Arthroplasty team consists of group of 11 Consultant Orthopaedic surgeons who specialise in joint replacements of all types. They are supported by Extended role nurses and physiotherapists. Within the team they cross refer more specialist problems or procedures.
Referral to this service is predominately for an opinion of suitability for a joint replacement for severe osteoarthritis assuming all conservative measures have been exhausted
Referral letters are triaged by the extended role practitioners. Patients are triaged based on the information in the referral and current XRs. Patients who have been seen previously will return to the original Consultant unless otherwise stated. Named referrals will be sent to the requested Consultant if clinically appropriate. Requests for further information to help triage will be made.
Advice can be provided. Referrals can be rerouted to other specialities.
Patients should not be referred unless they are prepared to subject themselves to a major operation with associated pain (especially knee replacement) and at least 8-12 weeks recovery time.
Who to refer:
Urgent Referral
- Infection of Implant
- Traumatic Failure
- Continued Extreme Pain (Continued extreme pain is generally considered to be patients who are on morphine based analgesia exculding codeine and Tramadol)
- Failure of Fracture Fixation
Routine Referral
- XRs of affected joint(s) are essential prior to referral to ensure suitability for the Arthroplasty service (ie severe OA)
- Hips: AP Pelvis with view of both hip joints
- Knees: AP both knees standing, with lateral view of the painful knee
Age itself is not a good predictor of outcome. Co morbidities including obesity and general fitness are more relevant. Please include this information on all referrals.
Hip Pain
- Pain predominately in groin radiating down the front of the thigh despite conservative treatments
- Night pain disturbing sleep regularly
- Restriction of range of movement in hip associated with pain
- Significant and progressive difficulty rising from a chair, getting out of bed, putting shoes and socks on
- Pain that is causing restriction of day to day life. eg. golf, dancing, walking
- Pain on sitting in one position for length of time
- Previous hip surgery which was pain free and has become persistently painful.
- Congenital Hip problem, now causing arthritis
Knee Pain
- Significant pain & swelling in the knee
- Restricted range of movement in the knee
- Pain along the joint line
- Visible deformity
- Difficulty rising out of a chair
- Night pain disturbing sleep regularly
- Reduced walking distance or difficulty with stairs
- Restriction of normal activities i.e. golf, dancing, walking
- First line analgesia does not relieve pain
- Previous knee surgery
For patients with knee pain without severe arthritis, please see Knee Ref Help pages.
If the patient has a Body Mass Index greater than 40, evidence shows there is a fivefold increased risk of complications in patients undergoing joint replacement surgery. These patients must be referred for weight reduction management first, and make a concerted effort to lose weight using all available options, no matter how severe the arthritis. This also helps improve their symptoms and health-related quality of life.
Who not to refer:
- Patients who have had a history of joint pain less than 6 months.
- Patients who have not tried physiotherapy
- Patients who’s symptoms are relieved by first line analgesia
- Patients who do not have severe OA on XR
How to refer:
- Use SCI Gateway for referrals :
- Hip: Lauriston Buildings > Orthopaedics – Arthroplasty Hip
- Knee: Lauriston Buildings > Orthopaedics – Arthroplasty Knee
- XRs of affected joint(s) are essential prior to referral to ensure suitability for the Arthroplasty service (ie severe OA)
- Hips: AP Pelvis with view of both hip joints
- Knees: AP both knees standing, with lateral view of the painful knee
