26th January 2024

Referral to other specialties

As part of the management strategy for OA, patients should be reviewed regularly to reinforce education and self-help advice and assess response to treatment. For patients who do not experience symptom resolution despite optimal self-management strategies and pharmacological therapies, referrals can be made to other members of the multidisciplinary team, including physiotherapists, occupational therapists, podiatrists, orthopaedic surgeons or pain clinics, depending on clinical scenario.

Surgery

Prior to referral for surgery, patients must have been offered non-pharmacological and pharmacological therapies. Surgical therapy should be considered for those patients who experience symptoms with a substantial impact on their function and quality of life and who are refractory to non-surgical management. Patient factors such as age, sex, smoking status, and BMI should not be considered as barriers to referral for surgery. Surgical treatment usually involves joint replacement or fusion; for patients with knee osteoarthritis with a history of mechanical locking, arthroscopic lavage and debridement may be considered. Complications associated with surgery include infection, aseptic loosening, pain and dislocation.

Adapted from: NICE guidelines: Osteoarthritis: care and management. National Institute for Health and Care Excellence (NICE); 2014

References 

• Conaghan PG, Dickson J, Grant RL. Care and management of osteoarthritis in adults: summary of NICE guidance. Bmj. 2008 Feb 28;336(7642):502-3.
• Graham DJ, Campen D, Hui R, Spence M, Cheetham C, Levy G, Shoor S, Ray WA. Risk of acute myocardial infarction and sudden cardiac death in patients treated with cyclo-oxygenase 2 selective and non-selective non-steroidal anti-inflammatory drugs: nested case-control study. The Lancet. 2005 Feb 5;365(9458):475-81.
• National Institute for Health and Care Excellence (Great Britain). Osteoporosis: assessing the risk of fragility fracture. National Institute for Health and Care Excellence (NICE); 2017