Hip and Knee Arthroplasty Referral Form Included

Hip and Knee pathway for patients with osteoarthritis requiring large joint arthroplasty only

Hip and knee arthroplasty referral form included

SUPPORTING NOTES

[1]Primary care treatment:

1a to 1e should be considered before referral to Orthopaedic Consultant is a realistic option.

[2]Advice:

Patient information leaflets are available on the following websites:

[3]Injection options to defer/avoid knee surgery:

To defer / avoid knee surgery for those who don’t want surgery consider options of Steroid injections.

For those GPs who don’t want to perform steroid injections there is the option of inter-practice referral for joint injections

[4]MSK referrals should contain the following information: Blood Pressure, BMI, eGFR {if appropriate} and HbA1C {if known diabetes} and a print-off of Past Medical History and Current Medication and Allergies. This will enable MSK services to refer straight on to a Consultant, if required.

[5]GP examination / assessment:

• GP to calculate Oxford score using on-line Oxford Hip or Oxford Knee Score (also attached in word format)
• Request X-ray to confirm moderate or severe Osteoarthritis [OA]. Record Blood Pressure. If GP has documented that BP under control, there is an agreement that the referral is accepted.
• Only if patient scores 30 or less on Oxford score and X-ray confirms moderate or severe Osteoarthritis and steps 1a-1e above have been tried as appropriate and the patient wants an operative procedure then refer Orthopaedic Surgical opinion.

[6]Referral information for surgery:

The following referral information for surgery is recommended by anaesthetists however it is acknowledged that being didactic about required levels is difficult, as the patient as a whole needs to be considered, rather than individual figures.

• Blood Pressure [BP]: For elective procedures patients should have BP's within the normotensive range. If a patient is a known hypertensive then the referral letter should give reassurance that recent BP measurements have been within the normal range, if they are not then treatment should be amended accordingly within primary care before referral. If a patient not known to be hypertensive is found to have a high reading then this should be addressed within primary care, either before referral, or, at the same time, so that a follow-up letter can be sent to the hospital confirming BP is within normal limits on several checks. If it is not, then treatment should be commenced.

• BMI: Limits here will be very much whole patient driven. A patient with a very high BMI with a non-life threatening condition may be considered suitable for surgery if they are in constant severe pain, whilst one that has only intermittent symptoms may be considered not suitable. All patients with a BMI greater than 30 should be given dietary advice at referral and consideration regarding delaying referral should occur with BMIs > 35. However, patients may be considered suitable with higher BMIs depending on symptomatology.

• EGFR {if appropriate}:No definite limits. This is likely to be something that is difficult to improve and therefore a low eGFR may alter the type of treatment offered and only in extreme cases is it likely to make the patient totally unsuitable for surgery and anaesthesia.

• HbA1c: The hospital policy on the management of the diabetic surgical patient states this should ideally be < 9%.

Hip and knee arthroplasty referral form

PLEASE NOTE: This form is to be accompanied by a referral letter and a data print out giving patient’s: Past medical history, drug history, allergies and social background

Site

Hip / Knee Right / Left / Bilateral

Diagnosis

Score

(**fields must be completed)

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