for general practitioners
Referral
When to Refer for Total Hip Arthroplasty
The decision about when to refer a patient for total hip arthroplasty requires a good understanding of the patient's joint disease and disability as well as social situation and other medical conditions. Through the basics of history taking, physical examination, laboratory and radiographic examination the general practitioner is the person best placed to help the patient make the decision whether to go ahead with a joint replacement or whether to wait.
The general rule is that joint replacement surgery is indicated if non-operative measures have failed to adequately control the patient's pain such that the joint disease is interfering with the patient's ability to enjoy his or her life. For some patients this may mean that they can no longer play 9 holes of golf and for others it may mean that they are having trouble walking around the house.
History
| Pain Profile |
| Site |
| Radiation |
| Duration |
| Relieving/exacerbating factors |
| Does the pain keep awake at night |
| |
|
| Function Profile |
| Walking distance |
| Walking aids |
| Getting in and out of cars |
| Using public transport |
| Taking shoes and socks on and off |
|
| Joint Profile |
| Clicking/grinding |
| Locking |
| Stiffness |
| Swelling |
| Giving away |
| Previous injuries |
| Previous surgery |
| Childhood hip problems |
|
Past medical history
- Tuberculosis
- Medications
- Steroids
- Allergies
- Family history
- Systems review
- Other joints affected
Examination of the hip
- Posture
- Lumbar spine, abdomen
- Surgical scars
- Tenderness - for example trochanteric bursitis
- Range of motion
- Signs: Trendellenburg lurch
- X-rays
Management of osteoarthritis of the hip
- Simple analgesics
- Nonsteroidal antiinflammatory medications
Walking aids
- Walking stick
- 2 walking sticks
- Shoe inserts
- Walking frame
- Wheelchair
Lifestyle modification
- Weight loss
- Activity modification
- Change of occupation
- Change of residence (level access)
When to refer for Total Knee Arthroplasty
The decision about when to refer a patient for total knee arthroplasty requires a good understanding of the patient's joint disease and disability as well as social situation and other medical conditions. Through the basics of history taking, physical examination, laboratory and radiographic examination the general practitioner is the person best placed to help the patient make the decision whether to go ahead with a joint replacement or whether to wait.
The general rule is that joint replacement surgery is indicated if non-operative measures have failed to adequately control the patient's pain such that the joint disease is interfering with the patient's ability to enjoy his or her life. For some patients this may mean that they can no longer play 9 holes of golf and for others it may mean that they are having trouble walking around the house.
History
| Pain Profile |
| Site |
| Radiation |
| Duration |
| Relieving/exacerbating factors |
Does the pain keep
awake at night |
| |
|
| Function Profile |
| Walking distance |
| Walking aids |
| Getting in and out of cars |
| Using public transport |
| Difficulty with stairs |
| Taking shoes and socks on and off |
|
| Joint Profile |
| Clicking/grinding |
| Locking |
| Stiffness |
| Swelling |
| Giving away |
| Previous injuries |
| Previous surgery |
|
Past medical history
- Tuberculosis
- Medications
- Steroids
- Allergies
- Family History
- Systems review
- Other joints affected
Examination of the knee
- Alignment
- Swelling - effusion vs bony swelling vs synovial swelling
- Tenderness
- Range of motion
- Signs: varus thrust
- Xrays
Management of osteoarthritis of the knee
- Simple analgesics
- Nonsteroidal antiinflammatory medications
Walking aids
- Walking stick
- 2 walking sticks
- Shoe inserts
- Walking frame
- Wheelchair
Lifestyle modification
- Weight loss
- Activity modification
- Change of occupation
- Change of residence (level access)
Common Hip Conditions
|
