specialist orthopaedic group
Increase Text Size Decrease Text Size Font resize print print
 
Knee Surgery Knee Replacement Spine Surgery
professional

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

professional
 
Bookmark and Share
© specialist orthopaedic group Your Practice Online