GP referral of patients with osteoarthritis for consideration of total joint replacement: A longitudinal study

Background: Individuals with hip or knee osteoarthritis (OA) are referred to orthopaedic surgeons if considered by their GP as potential candidates for total joint replacement (TJR). It is not clear which patients end up having this surgery. Aim: The aimof the study was to investigate symptomvariation in individuals with OA newly referred by GPs to an orthopaedic surgeon for consideration for TJR, and to determine the predictors of having this procedure. Design and setting: A longitudinal study of patients at a regional orthopaedic centre with follow-up at 3, 6, and 12months by postal questionnaire. Method: GP referrals of patients with OA to orthopaedic surgeons were consecutively sampled. Of the 431 eligible patients, 257 (59.6%) were recruited. Validatedmeasurement tools were used tomeasure pain, physical functioning, severity of OA, and health-related quality of life. Results: Over half the participants were in constant pain, taking painmedicationmore than once per day. Only 67 of 134 (50%) hip and 40 of 123 (33%) knee patients had a TJR within 12months. Those who had a replacement had been diagnosed with OA for a shorter time, reported more frequent pain, weremore likely to use a walking stick, and had worse pain, stiffness, and physical functioning. Conclusion: Many individuals considered for TJR ultimately may not have surgery, andmore effective strategies ofmanagement need to be developed between primary and secondary care to achieve better outcomes and to improve quality of care. ©British Journal of General Practice.