MANAGEMENT OF BACK PAIN IN PRIMARY CARE



CHECKLIST FOR REFERRAL FOR KNEE REPLACEMENT

|Patient Name: |Yes/No |

|Is the patient over 50 years old?1 | |

|Have you established whether the patient suffering from pain arising from the knee joint?2 | |

|Are there signs of deformity and/or loss of movement associated with pain?2 | |

|Has the patient had a standing AP and lateral view of the knee that confirms osteoarthritis? Has the X-ray been | |

|done at the hospital to which you are referring the patient?3 | |

|Has the patient had a trial of adequate analgesia?4 e.g. paracetamol 1g 2-3 times a day and naproxen 500mg twice | |

|daily for 2 months | |

|Is the patient’s knee pain significantly impacting on the patient’s quality of life and their ability to carry | |

|out activities of daily living?4 e.g. rest pain, night pain, diminishing walking distance, etc. And will their | |

|quality of life improve with a total knee replacement? | |

|If the patient has co-morbidities, are they fit for surgery? Have the risks of surgery been discussed with the | |

|patient?5 | |

|Is the patient prepared to attend for surgery within 3 months from referral?5 e.g. Are they in the country? | |

|Reason for referring if answering ‘No’ to any of above:- | |

| | |

1 Osteoarthritis of the knee is unusual in patients below 50 years of age unless there is a previous history that suggests osteoarthritis. Knee pain in younger patients is due to anterior knee pain or intraarticular pathology.

2 Arthritis of the hip can be referred to the anterior thigh and/or knee

3 A standing view of the knee gives a more accurate assessment of osteoarthritis, and should be done at the hospital which the patient would like to attend if they require referral to avoid duplication of investigations

4 Patients should be managed in primary care with adequate analgesia, encouragement to lose weight and increase exercise until they have significantly serious pain that they will consider joint replacement. Physiotherapy may also be indicated.

5 Orthopaedic surgeons do not need to see patients unless they are candidates for surgery and are fit and available for surgery to be performed

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