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Referral of patients with osteoarthritis for consideration for joint replacement surgery

Issue 34 Synovium (Autumn 2011)

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With osteoarthritis (OA) being one of the most common musculoskeletal conditions, and with the ageing and increasingly sedentary population, referral of patients whose joint symptoms are difficult to manage is increasing in primary care.

A study published in the British Journal of General Practice1 looked at the outcomes of 257 patients referred to a regional orthopaedic centre for consideration for joint replacement. Only 50% of patients with OA hip and 33% of patients with OA knee had undergone joint replacement 12 months after referral. Having a new joint was associated with increased frequency and severity of pain and stiffness, a shorter duration of symptoms, poorer physical function and use of a walking stick.

The decision-making around joint replacement is complex and multidimensional, as the authors acknowledge. It is influenced by many factors in addition to those directly related to the joint in question. Patient preferences, comorbidities and alternative treatments are some that were not examined in this study. The authors advise that referring clinicians should ensure that patients are fully informed, fully educated, and both agreeable to and fit for surgery before making the referral. We would add that patients should have explored all the simple, safe and cost-effective treatments that Synovium has previously featured.

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