This page has not been updated since 05-10-23, please bear this in mind when following this guidance
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 letters are triaged by the Extended role practitioners and appointed to an appropriate member of the team at the nearest location and time. Patients are triaged on the information drawn from in the referral. If a patient needs to be seen within another sub-specialty in MSK this is carried out at the point of Triage.
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.
Currently written advice is sent back to GP’s for those patients in whom there is insufficient information on the referral letter to suggest that an orthopaedic review is appropriate. This is being piloted and feedback would be appreciated.
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 (Usually added to the next clinic as an overbooking)
- 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 (currently aiming for a maximum wait of 9 weeks)
Age of itself is not a good predictor of outcome, co morbidities and general fitness are more important.
- Hip Pain
- pain in hip or 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.
- Pain that is causing restriction of day to day life. i.e. 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
- Knee pain
- Pain & swelling in the knee
- Restricted Range of movement in the knee
- Pain along the joint line
- Crepitus
- Heat in the knee
- Visible deformity
- Difficulty rising out of a chair
- Reduced walking distance or difficulty with stairs
- Difficulty getting out of bed
- Restriction of normal activities i.e. golf, dancing, walking
- Pain on sitting in one position for length of time
- First line analgesia does not relieve pain
- Previous knee surgery
If the patient has a Body Mass Index greater than 40, then referral to Orthopaedics should not be the first step as evidence shows a significant increased risk of complications in these patients. 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 normally takes at least 6-12 months. If the patient manages significant weight reduction to BMI <40 then they can be referred on to Orthopaedics, taking into consideration the advice below. Exceptions can be made for individual cases, but not for the excuse ‘I can’t lose weight because I can’t exercise’. Please see the advice from the British Heart Society, April 2015: ‘Patients do not need to do one iota of exercise to lose weight, they just need to eat less’
Age is less important than symptoms
If the patient meets the criteria above, the crucial question to ask is whether or not they would consider that the problem is bad enough to subject themselves to a major operation with associated pain (especially knee replacement) and at least 8-12 weeks recovery time. If the patient says no, then they should NOT be referred until they get to that stage
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
- Advice with regard to the management of patients with joint pain will be accepted and dealt with quickly
How to refer:
- Use Gateway for referrals centrally through RIE Patients will be seen at a hospital in their local area if an appropriate specialist is available at their local centre.
- It would be useful to obtain x-rays of the joints prior to referral
- Hips: AP Pelvis with view of both hip joints
- Knees: AP both knees standing, with lateral view of the painful knee
- Assessment of known co-morbidities and general fitness will ensure a smooth journey through the arthroplasty pathway.
National Institute for Health and Care Excellence https://www.nice.org.uk/
Scottish Intercollegiate Guidelines Network SIGN
