Hip and Knee

Availability

North South North West Statewide

Pre-referral work-up

History

Refer emergencies to the Emergency Department and for all other patients

Consider referral if unresponsive to conservative therapy and the patient has:

  • Significant pain
  • Pain interfering with activities of daily living
  • Problems relating to mobility
  • Pain causing sleep disturbance
  • Deteriorating quality of life

Conditions generally treated include:-

  • Osteoarthritis
  • Inflammatory arthritis
  • Post traumatic arthritis,
  • Avascular necrosis
  • Apophysitis (e.g. Osgood Schlatters) which does not settle.

All referrals should comply to referral standards and include in particular:

  • The precipitating event for referral (if any).
  • The patient’s General Medical condition and current medication (include history of recurrent infections if any)
  • If there is Rest pain and sleep disturbance
  • The Effect on daily duties eg ability to earn or ability to provide care for dependents
  • Any Conservative management undertaken including details of any measures undertaken by allied health and patient to improve mobility, reduce weight, improve exercise tolerance.
  • Current medications and previous medications trialed
  • Previous joint surgery
  • The use of walking aid and Walking distance,
  • The ability to dress self ( including shoes), night pain,
  • Examination findings including range of movement and deformity.
  • If possible please complete the Hip and Knee questionnaire

Tests

  • X-ray (AP pelvis and lateral hip including weight bearing/standing views)
  • X-ray (AP weight bearing, notch, lateral, patellar skyline views)

Interim/GP management

To refer a patient with this condition, please see the Orthopaedic Surgery clinic page for the full referral process and templates.

Advise, educate, assist and enable the patient to achieve maximal function and comfort without surgery and to maximise health prior to surgery if it is to occur.

Conservative management with referral (where possible) to allied health professionals such as physiotherapists, exercise physiologists, occupational therapists, dieticians or psychologists is shown to be of benefit and may result in no need for referral to clinic for orthopaedic opinion.

Use of NSAIDS or other appropriate analgaesia especially guiding for use prior to activity.

Maximise control of co-morbidities eg diabetes, COPD,  asthma, alcohol or drug dependence.

Advise on smoking cessation and the associated improvement in healing.

Note: All new hip and knee referrals will be triaged by a joint assessment clinic (see COAP in southern Tasmania. The patient will be sent a self-assessment questionnaire if not provided with the referral and invited to attend a clinic for assessment.

  • Medication
  • Activity modification
  • Community physiotherapy
  • Weight reduction methods
  • Walking aids

Direct link to Health Pathways - Hip and Knee folder

For more information please see the Tasmanian Health Pathways website.

Emergency

Septic arthritis

Acute disclocation

Fractures

Urgent / category 1

Pain in previous arthroplasty especially if infection is suspected

Avascular necrosis

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

RACGP Referral for Joint Replacement: A management guide for health providers

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED
– Phone: (03) 6777 6405  Fax: (03) 6348 7382
MCH ED
– Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED
– Phone: (03) 6493 6340  Fax: (03) 6464 1926
RHH ED
– Phone: (03) 6166 6100  Fax: (03) 6173 0489

Urgent:
Urgent referrals (including fractures) should be accompanied by a phone call to the Registrar to organise urgent review in clinic and the referral must be faxed.

We will endeavour to see these patients within four weeks, or sooner if clinically indicated.

Semi-urgent:

We will endeavour to see these patients within 12 weeks

Routine:

Next available appointment