[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ fullwidth=”on” disabled_on=”on|off|off” _builder_version=”4.16″ _module_preset=”default” background_color=”#c7c89b” background_enable_image=”off” background_size=”contain” background_position=”center_left” custom_margin=”-12px||||false|false” custom_margin_tablet=”-12px||||false|false” custom_margin_phone=”0px||||false|false” custom_margin_last_edited=”on|phone” custom_padding=”||33px||false|false” global_colors_info=”{}”][et_pb_fullwidth_image src=”https:\/\/toolkit.albertaboneandjoint.com\/osteoarthritis\/wp-content\/uploads\/line-1.png” title_text=”line (1)” _builder_version=”4.16″ _module_preset=”default” width=”80%” max_width=”80%” global_colors_info=”{}”][\/et_pb_fullwidth_image][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”4.16″ _module_preset=”default” custom_margin=”0px||0px||true|false” custom_padding=”0px||0px||true|false” top_divider_color=”rgba(12,113,195,0.32)” top_divider_height=”27px” global_colors_info=”{}”][et_pb_row _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][lwp_divi_breadcrumbs _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][\/lwp_divi_breadcrumbs][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ custom_padding_last_edited=”on|phone” _builder_version=”4.16″ _module_preset=”default” background_color=”#FFFFFF” custom_padding=”0px||||false|false” custom_padding_tablet=”” custom_padding_phone=”0px||0px||true|false” global_colors_info=”{}”][et_pb_row column_structure=”1_2,1_2″ _builder_version=”4.17.4″ _module_preset=”default” custom_margin=”||0px||false|false” custom_padding=”||0px||false|false” global_colors_info=”{}”][et_pb_column type=”1_2″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_text module_class=”heading” _builder_version=”4.17.4″ _module_preset=”default” text_font=”|600||on|||||” text_text_color=”#000000″ text_font_size=”40px” header_text_color=”#000000″ header_2_font=”Source Sans Pro|600|||||||” header_2_text_align=”center” header_2_text_color=”#ffc212″ header_2_line_height=”1.4em” custom_padding=”||||false|false” header_2_text_shadow_style=”preset1″ global_colors_info=”{}”]<\/p>\n
OVERVIEW<\/p>\n
[\/et_pb_text][\/et_pb_column][et_pb_column type=”1_2″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=”1_2,1_2″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”1_2″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.16″ _module_preset=”default” text_font_size=”18px” global_colors_info=”{}”]Key Messages for Joint Surgery Referral<\/strong><\/p>\n [\/et_pb_text][\/et_pb_column][et_pb_column type=”1_2″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.17.4″ _module_preset=”default” text_text_color=”#000000″ text_font_size=”18px” background_color=”#f2f2f2″ custom_padding=”20px|20px|20px|20px|true|true” border_radii=”on|20px|20px|20px|20px” global_colors_info=”{}”]<\/p>\n View All Resources<\/strong><\/a><\/p>\n View References<\/strong><\/a>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ module_class=”desk” _builder_version=”4.16″ _module_preset=”default” background_color=”rgba(255,255,255,0.86)” background_image=”https:\/\/toolkit.albertaboneandjoint.com\/osteoarthritis\/wp-content\/uploads\/Pngtree\u2014blue-hexagon-abstract-medical-technology_1298247-e1653654071890.jpg” background_size=”initial” background_position=”top_left” background_blend=”overlay” custom_margin=”||||false|true” custom_padding=”||100px||false|true” global_colors_info=”{}”][et_pb_row column_structure=”1_4,3_4″ _builder_version=”4.18.0″ _module_preset=”d55fc8c6-b5de-4b77-a65b-80d125d2b382″ global_colors_info=”{}”][et_pb_column type=”1_4″ _builder_version=”4.18.0″ _module_preset=”e067a3d0-44a1-4396-9c39-e633c5db2c25″ background_color=”rgba(255,255,255,0.64)” global_colors_info=”{}”][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]Introduction<\/a>[\/et_pb_text][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]When to refer<\/a>[\/et_pb_text][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]Trial conservative care<\/a>[\/et_pb_text][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]Starting & completing referral<\/a>[\/et_pb_text][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]Surgical care path<\/a>[\/et_pb_text][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]Surgical candidacy<\/a>[\/et_pb_text][et_pb_text _builder_version=”4.18.0″ _module_preset=”46786535-2f5d-4ee1-8e00-c908da837293″ global_colors_info=”{}”]Ongoing management<\/a>[\/et_pb_text][\/et_pb_column][et_pb_column type=”3_4″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”||||false|false” global_colors_info=”{}”][et_pb_text _builder_version=”4.18.0″ _module_preset=”default” text_font_size=”18px” global_colors_info=”{}”]<\/p>\n Despite optimizing non-surgical <\/span><\/span> options, individuals with osteoarthritis (OA) may still experience a progression of symptoms and deterioration of function and mobility, which impacts their quality of life. At this time, a referral for joint surgery may be appropriate for advanced pain management. An adequate trial of supported conservative care is strongly recommended before joint surgery is considered. This will help to ensure that appropriate candidates are referred for a consult with a surgeon in a timely manner.<\/p>\n This referral decision for joint surgery should be supported with:<\/p>\n Individuals who are beyond non-surgical <\/span><\/span> treatment may require an \u2018urgent\u2019 referral to surgery<\/a>.<\/strong><\/p>\n This standard aligns with the most recent Hip and Knee Surgical Care Path<\/a><\/p>\n<\/div>\n [\/et_pb_text][et_pb_divider color=”#000000″ _builder_version=”4.16″ _module_preset=”default” custom_margin=”20px||||false|false” custom_padding=”20px||||false|false” global_colors_info=”{}”][\/et_pb_divider][et_pb_text _builder_version=”4.17.4″ _module_preset=”default” text_font_size=”18px” global_colors_info=”{}”]<\/p>\n If the individual with OA reports a progression of symptoms and functional decline which has not improved after an adequate trial of conservative care (below), a referral for joint surgery may be considered. Indicators of declining conditions include:<\/p>\n [\/et_pb_text][et_pb_divider color=”#000000″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”20px||||false|false” global_colors_info=”{}”][\/et_pb_divider][et_pb_text _builder_version=”4.18.0″ _module_preset=”default” text_font_size=”18px” global_colors_info=”{}”]<\/p>\n Education sessions can be delivered in verbal, written and\/or virtual formats.<\/p>\n The OA Self Management Education Booklet aligns with the topics for an introduction to OA education<\/a> and can be provided to the individual with OA as early as first confirmation of diagnosis. There is also an accompanying Powerpoint presentation for the booklet. Examples of publicly available materials are provided in the Health Resources Matrix.<\/p>\n Look for community organizations as well as health organizations to find applicable educational programs. For instance, a recreation centre may have an OA focused class. Build relationships with local educational programs and keep a Resource Inventory up to date with the program schedule for these classes and to ensure individuals with OA are directed to the program that is most applicable to their gaps in knowledge.<\/p>\n If there are no local education programs running in the area, consider running one. Consider using group teaching to build a community for individuals with OA to connect with one another. Locally developed materials should align with these standards, the Conservative OA Treatments and best evidence. Successful education material should be presented in \u2018patient friendly\u2019 language and offer opportunities for interaction and question answering. Consider partnering with other agencies or programs as well to deliver a multi-disciplinary approach.<\/p>\n<\/div>\n [\/et_pb_text][et_pb_divider color=”#000000″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”20px||||false|false” global_colors_info=”{}”][\/et_pb_divider][et_pb_text _builder_version=”4.18.0″ _module_preset=”default” text_font_size=”18px” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n Before referring an individual for surgical consultation, the Primary Clinician should advise the individual that there are risks and benefits of surgical joint replacement, and there should be a discussion about appropriate expectations for functional outcome after surgery. Surgical options for hip or knee OA can include total joint replacements, partial replacements (hemiarthroplasty), joint resurfacing, and revisions. It is important to discuss whether surgery would effectively meet the individual\u2019s health needs and evaluate their willingness to undergo the surgical preparation and rehabilitation processes. Although, the surgeon will explain the details of any risk factors with the individual, the referring clinician should discuss with the individual that:<\/p>\n Once the individual provides informed consent for the coordination of a referral, they may be guided through the process. Refer to the provincially standardized Hip and Knee Referral Form<\/a> and the Alberta Referral Directory<\/a> to refer the individual to one of the eleven Albertan hip and knee central intake clinics.<\/p>\n The referral form should be complete and compiled with the required appropriate x-rays<\/a>, additional applicable details on medical history and a history of the conservative treatments trialed to date. If the referral is not complete, the referring clinic will send the original referral form back to the referring clinician and request outstanding information. This should be avoided as it may result in delays for the individual\u2019s wait times for surgeon consult.<\/p>\n Support the individual with OA to understand that their first assessment at the Hip and Knee Central Intake Clinic will be screened to evaluate whether they are an appropriate candidate for surgery<\/a>, and a consult with a surgeon may follow after that. Candidacy for surgery will be evaluated at the surgeon consult again. It is important to empower the individual with OA to take an active role in discussing the criteria for surgery and the status of their comorbidities with both the specialist screening physician (if applicable) and the surgeon. It is also important to emphasize that their OA care will not end if surgery is not the correct step for them (see below).<\/p>\n An individual\u2019s candidacy for surgery may evolve with time. <\/strong>Collaboration between the individual and all clinicians (including the screening specialist and\/or surgeon) is essential to ensure up to date information about symptoms and quality of life is documented and the individual\u2019s care plan is current.<\/p>\n With the full implementation of these standards the relationship between referring clinician and surgeon will shift over time. A more equal partnership in optimizing the individual with OA for surgery will be possible with a broader understanding of conservative OA management and the criteria for risk reduction prior to surgery.<\/p>\n Steroid injections should not be performed less than six weeks before the date of surgery.<\/p>\n<\/div>\n [\/et_pb_text][et_pb_divider color=”#000000″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”20px||||false|false” global_colors_info=”{}”][\/et_pb_divider][et_pb_text _builder_version=”4.18.0″ _module_preset=”default” text_font_size=”18px” hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n The Hip and Knee Surgical Care Path is authored by the Albertan Hip and Knee Replacement Clinical Committee. The Clinical Committee is a partnership between the Alberta Orthopaedic Society<\/a> and the Bone and Joint Health Strategic Clinical Network<\/a>.<\/p>\n As well as inpatient care requirements for hip or knee joint replacement, the care path details criteria for:<\/p>\n It is recognized that clinician familiarity with the Hip and Knee Surgical Care Path is limited outside of the orthopaedic surgeons\u2019 practices. With the full implementation of these standards, the familiarity with the care path will grow over time.<\/p>\n Referral to orthopaedic surgeons at their central-intake hip and knee clinics does vary in Alberta, despite the Hip and Knee Surgical Care Path. This is because surgeons\u2019 practices vary slightly across the province: some surgeons offer individuals a variety of non-surgical OA treatment options, other surgeons do not include OA management treatments in their scope of work. With the implementation of this standard, the\u00a0OA treatment trial period<\/a> will be formalized, regardless of the clinician supporting that trial.<\/p>\n<\/div>\n [\/et_pb_text][et_pb_divider color=”#000000″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”20px||||false|false” global_colors_info=”{}”][\/et_pb_divider][et_pb_text _builder_version=”4.18.0″ _module_preset=”default” text_font_size=”18px” global_colors_info=”{}”]<\/p>\n Pain medications must be prescribed very carefully, and a full history of the individual\u2019s active prescriptions, history of addictions, comorbidities and pain experience must be evaluated. Based on the pharmaceutical treatment algorithm, develop a tailored medication plan taking into consideration the individual\u2019s symptoms, ability to participate in Core Treatments, other health conditions, values and preferences.<\/p>\n Use the Resource Inventory<\/a> to track which Adjunct Treatments are available locally. Use the Tables of Examples of Conservative OA Treatments to consider the breadth of options for adjunct treatments.<\/p>\n Standard 3<\/a> describes how it is every clinician\u2019s responsibility to communicate to the Primary Clinician, and vice versa. Any changes in the care plan or health status of the individual should be communicated. This is particularly important for the management of pharmacological treatments. Communications between clinicians can emphasize that the goal is to provide Adjunct Treatments to encourage return to Core Treatments.<\/p>\n At all follow-up visits, work with your individual with OA to reassess, track, and modify their Adjunct Treatments to better reflect their current needs and progress. This collaborative process will improve commitment to Core Treatments.<\/p>\n<\/div>\n [\/et_pb_text][et_pb_divider color=”#000000″ _builder_version=”4.16″ _module_preset=”default” custom_padding=”20px||||false|false” global_colors_info=”{}”][\/et_pb_divider][et_pb_text _builder_version=”4.17.4″ _module_preset=”default” text_font_size=”18px” global_colors_info=”{}”]<\/p>\n It is important to note that conservative (non-surgical) care does not stop after:<\/strong><\/p>\n The continuation of conservative treatments will:<\/p>\n At follow-up visits, after surgery, continue to recommend appropriate conservative management options in order to conserve the repaired joint, speed recovery, maximize function and conserve other joints.<\/p>\n<\/div>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ module_class=”mob” _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_row _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_accordion _builder_version=”4.18.0″ _module_preset=”7edfcb3f-f900-45e5-aca9-ee6492dc7b76″ hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″][et_pb_accordion_item open=”on” _builder_version=”4.16″ _module_preset=”default” custom_css_main_element=”display:none;” global_colors_info=”{}”][\/et_pb_accordion_item][et_pb_accordion_item title=”INTRODUCTION” _builder_version=”4.18.0″ _module_preset=”default” global_colors_info=”{}” open=”off”]<\/p>\n Despite optimizing non-surgical <\/span><\/span> options, individuals with osteoarthritis (OA) may still experience a progression of symptoms and deterioration of function and mobility, which impacts their quality of life. At this time, a referral for joint surgery may be appropriate for advanced pain management. An adequate trial of supported conservative care is strongly recommended before joint surgery is considered. This will help to ensure that appropriate candidates are referred for a consult with a surgeon in a timely manner.<\/p>\n This referral decision for joint surgery should be supported with:<\/p>\n Individuals who are beyond non-surgical <\/span><\/span> treatment may require an \u2018urgent\u2019 referral to surgery<\/a>.<\/strong><\/p>\n This standard aligns with the most recent Hip and Knee Surgical Care Path<\/a><\/p>\n [\/et_pb_accordion_item][et_pb_accordion_item title=”WHEN TO REFER” _builder_version=”4.17.4″ _module_preset=”default” global_colors_info=”{}” open=”off”]If the individual with OA reports a progression of symptoms and functional decline which has not improved after an adequate trial of conservative care (below), a referral for joint surgery may be considered. Indicators of declining conditions include:<\/p>\n [\/et_pb_accordion_item][et_pb_accordion_item title=”TRIAL CONSERVATIVE CARE” _builder_version=”4.18.0″ _module_preset=”default” global_colors_info=”{}” open=”off”]Education sessions can be delivered in verbal, written and\/or virtual formats.<\/p>\n The OA Self Management Education Booklet aligns with the topics for an introduction to OA education<\/a> and can be provided to the individual with OA as early as first confirmation of diagnosis. There is also an accompanying Powerpoint presentation for the booklet. Examples of publicly available materials are provided in the Health Resources Matrix.<\/p>\n Look for community organizations as well as health organizations to find applicable educational programs. For instance, a recreation centre may have an OA focused class. Build relationships with local educational programs and keep a Resource Inventory up to date with the program schedule for these classes and to ensure individuals with OA are directed to the program that is most applicable to their gaps in knowledge.<\/p>\n If there are no local education programs running in the area, consider running one. Consider using group teaching to build a community for individuals with OA to connect with one another. Locally developed materials should align with these standards, the Conservative OA Treatments and best evidence. Successful education material should be presented in \u2018patient friendly\u2019 language and offer opportunities for interaction and question answering. Consider partnering with other agencies or programs as well to deliver a multi-disciplinary approach.[\/et_pb_accordion_item][et_pb_accordion_item title=”STARTING & COMPLETING REFERRAL” _builder_version=”4.18.0″ _module_preset=”default” global_colors_info=”{}” open=”off”]Before referring an individual for surgical consultation, the Primary Clinician should advise the individual that there are risks and benefits of surgical joint replacement, and there should be a discussion about appropriate expectations for functional outcome after surgery. Surgical options for hip or knee OA can include total joint replacements, partial replacements (hemiarthroplasty), joint resurfacing, and revisions. It is important to discuss whether surgery would effectively meet the individual\u2019s health needs and evaluate their willingness to undergo the surgical preparation and rehabilitation processes. Although, the surgeon will explain the details of any risk factors with the individual, the referring clinician should discuss with the individual that:<\/p>\n Once the individual provides informed consent for the coordination of a referral, they may be guided through the process. Refer to the provincially standardized Hip and Knee Referral Form<\/a> and the Alberta Referral Directory<\/a> to refer the individual to one of the eleven Albertan hip and knee central intake clinics.<\/p>\n The referral form should be complete and compiled with the required appropriate x-rays<\/a>, additional applicable details on medical history and a history of the conservative treatments trialed to date. If the referral is not complete, the referring clinic will send the original referral form back to the referring clinician and request outstanding information. This should be avoided as it may result in delays for the individual\u2019s wait times for surgeon consult.<\/p>\n Support the individual with OA to understand that their first assessment at the Hip and Knee Central Intake Clinic will be screened to evaluate whether they are an appropriate candidate for surgery<\/a>, and a consult with a surgeon may follow after that. Candidacy for surgery will be evaluated at the surgeon consult again. It is important to empower the individual with OA to take an active role in discussing the criteria for surgery and the status of their comorbidities with both the specialist screening physician (if applicable) and the surgeon. It is also important to emphasize that their OA care will not end if surgery is not the correct step for them (see below).<\/p>\n An individual\u2019s candidacy for surgery may evolve with time. <\/strong>Collaboration between the individual and all clinicians (including the screening specialist and\/or surgeon) is essential to ensure up to date information about symptoms and quality of life is documented and the individual\u2019s care plan is current.<\/p>\n With the full implementation of these standards the relationship between referring clinician and surgeon will shift over time. A more equal partnership in optimizing the individual with OA for surgery will be possible with a broader understanding of conservative OA management and the criteria for risk reduction prior to surgery.<\/p>\n Steroid injections should not be performed less than six weeks before the date of surgery.[\/et_pb_accordion_item][et_pb_accordion_item title=”SURGICAL CARE PATH” _builder_version=”4.18.0″ _module_preset=”default” hover_enabled=”0″ global_colors_info=”{}” open=”off” sticky_enabled=”0″]The Hip and Knee Surgical Care Path is authored by the Albertan Hip and Knee Replacement Clinical Committee. The Clinical Committee is a partnership between the Alberta Orthopaedic Society<\/a> and the Bone and Joint Health Strategic Clinical Network<\/a>.<\/p>\n As well as inpatient care requirements for hip or knee joint replacement, the care path details criteria for:<\/p>\n It is recognized that clinician familiarity with the Hip and Knee Surgical Care Path is limited outside of the orthopaedic surgeons\u2019 practices. With the full implementation of these standards, the familiarity with the care path will grow over time.<\/p>\n Referral to orthopaedic surgeons at their central-intake hip and knee clinics does vary in Alberta, despite the Hip and Knee Surgical Care Path. This is because surgeons\u2019 practices vary slightly across the province: some surgeons offer individuals a variety of non-surgical OA treatment options, other surgeons do not include OA management treatments in their scope of work. With the implementation of this standard, the\u00a0OA treatment trial period<\/a> will be formalized, regardless of the clinician supporting that trial.[\/et_pb_accordion_item][et_pb_accordion_item title=”SURGICAL CANDIDACY” _builder_version=”4.18.0″ _module_preset=”default” global_colors_info=”{}” open=”off”]<\/p>\n Pain medications must be prescribed very carefully, and a full history of the individual\u2019s active prescriptions, history of addictions, comorbidities and pain experience must be evaluated. Based on the pharmaceutical treatment algorithm, develop a tailored medication plan taking into consideration the individual\u2019s symptoms, ability to participate in Core Treatments, other health conditions, values and preferences.<\/p>\n Use the Resource Inventory<\/a> to track which Adjunct Treatments are available locally. Use the Tables of Examples of Conservative OA Treatments to consider the breadth of options for adjunct treatments.<\/p>\n Standard 3<\/a> describes how it is every clinician\u2019s responsibility to communicate to the Primary Clinician, and vice versa. Any changes in the care plan or health status of the individual should be communicated. This is particularly important for the management of pharmacological treatments. Communications between clinicians can emphasize that the goal is to provide Adjunct Treatments to encourage return to Core Treatments.<\/p>\n At all follow-up visits, work with your individual with OA to reassess, track, and modify their Adjunct Treatments to better reflect their current needs and progress. This collaborative process will improve commitment to Core Treatments.<\/p>\n [\/et_pb_accordion_item][et_pb_accordion_item title=”ONGOING MANAGEMENT” _builder_version=”4.18.0″ _module_preset=”default” hover_enabled=”0″ global_colors_info=”{}” open=”off” sticky_enabled=”0″]It is important to note that conservative (non-surgical) care does not stop after:<\/strong><\/p>\n The continuation of conservative treatments will:<\/p>\n At follow-up visits, after surgery, continue to recommend appropriate conservative management options in order to conserve the repaired joint, speed recovery, maximize function and conserve other joints.[\/et_pb_accordion_item][\/et_pb_accordion][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”4.17.4″ _module_preset=”default” custom_margin=”0px||0px||true|false” custom_padding=”0px|0px|0px|0px|true|true” global_colors_info=”{}”][et_pb_row _builder_version=”4.17.4″ _module_preset=”default” custom_margin=”0px||0px||true|false” custom_padding=”0px||0px||true|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”]VIEW NEXT<\/span><\/a>[\/et_pb_text][et_pb_text _builder_version=”4.17.4″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”4.16″ _module_preset=”default” custom_margin=”0px|0px|0px|0px|false|false” custom_padding=”0px|0px|0px|0px|false|false” global_colors_info=”{}”][et_pb_row _builder_version=”4.17.4″ _module_preset=”default” background_color=”#FFFFFF” width=”100%” max_width=”2560px” custom_margin=”0px||0px||true|false” custom_padding=”0px|0px|0px|0px|true|true” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][el_modal_popup modal_id=”learn-more-urgent-referral” trigger_element_type=”element_class” trigger_element_class=”learn-more-urgent-referral” close_on_esc=”on” modal_title=”Immediate or \u2018Urgent\u2019 Referral to Orthopaedic Surgeon” show_footer=”off” _builder_version=”4.18.0″ _module_preset=”0e4bb1fa-d312-42c0-b873-269eda7f61b5″ global_module=”10105″ saved_tabs=”all” global_colors_info=”{}”]<\/p>\n The goal with these standards is to encourage an adequate trial of non-surgical (conservative) OA treatment prior to referral to a surgeon (Standard 8)<\/a>. However, there are certain criteria that would result in an \u2018urgent\u2019 classification of the individual, and therefore warrant immediate referral to an orthopaedic surgeon.<\/strong> The individual\u2019s experience is very important to consider as an arthroplasty has positive health outcomes for many individuals and can help them return to OA management faster.<\/p>\n Refer immediately to an orthopaedic surgeon if:<\/p>\n [\/el_modal_popup][el_modal_popup modal_id=”learn-more-hip-knee-surgical-care-path” trigger_element_type=”element_class” trigger_element_class=”learn-more-hip-knee-surgical-care-path” modal_title=”Hip and Knee Surgical Care Path” show_footer=”off” _builder_version=”4.18.0″ _module_preset=”0e4bb1fa-d312-42c0-b873-269eda7f61b5″ global_module=”10108″ saved_tabs=”all” global_colors_info=”{}”]<\/p>\n The Hip and Knee Surgical Care Path is authored by the Alberta Hip and Knee Replacement Clinical Committee. The Clinical Committee is a partnership between the Alberta Orthopaedic Society and the Bone and Joint Health Strategic Clinical Network.<\/p>\n As well as inpatient care requirements for hip or knee joint replacement, the care path details criteria for:<\/p>\n It is recognized that clinician familiarity with the Hip and Knee Surgical Care Path is limited outside of the orthopaedic surgeons\u2019 practices. With the full implementation of these standards, the familiarity with the care path will grow over time.<\/p>\n Referral to orthopaedic surgeons at their central-intake hip and knee clinics does vary in Alberta, despite the Hip and Knee Surgical Care Path. This is because surgeons\u2019 practices vary slightly across the province: some surgeons offer individuals a variety of non-surgical OA treatment options, other surgeons do not include OA management treatments in their scope of work. With the implementation of this standard, the OA treatment trial period will be formalized, regardless of the clinician supporting that trial.<\/p>\n<\/div>\n [\/el_modal_popup][el_modal_popup modal_id=”learn-more-surgical-candidacy” trigger_element_type=”element_class” trigger_element_class=”learn-more-surgical-candidacy” close_on_esc=”on” modal_title=”Surgical Candidacy” show_footer=”off” _builder_version=”4.18.0″ _module_preset=”0e4bb1fa-d312-42c0-b873-269eda7f61b5″ global_module=”10111″ saved_tabs=”all” global_colors_info=”{}”]<\/p>\n An individual with osteoarthritis (OA) is not an appropriate candidate for elective hip or knee joint replacement surgery in Alberta if:<\/p>\n Note: capture of formal PROMs varies across the province and may represent some administrative obstacles to a clinic\/clinician. With the full implementation of these standards these obstacles will be overcome with time through the support of the Bone and Joint Health Strategic Clinical Network (BJH SCN) and its collaborators (Standard 9)<\/a>.<\/p>\n Often surgeons will not recommend elective (non emergent) joint replacement surgery for individuals with unmanaged comorbidities that carry excessive medical risk for the surgery, such as:<\/p>\n If the individual is managing their comorbidities, evaluation of candidacy will be a discussion with the surgeon. If comorbidities are unmanaged, pre-operative surgical optimization at the Hip and Knee Central Intake Clinic may be appropriate, or the individual may need to return to their Primary Clinician to create care plans for their other conditions. The Hip and Knee Central Intake Clinic is responsible for communicating their decision about surgical candidacy and any medical recommendations back to the primary referring clinician, typically by letter.<\/p>\n Note: surgeons\u2019 practices vary slightly across the province: some surgeons offer individuals a variety of non-surgical OA treatment options, other surgeons do not include OA management treatments in their scope of work. With the implementation of this standard, the OA treatment trial period will be formalized, regardless of the clinician supporting that trial.<\/p>\n<\/div>\n [\/el_modal_popup][el_modal_popup modal_id=”learn-more-additional-investigation-information” trigger_element_type=”element_class” trigger_element_class=”learn-more-additional-investigation-information” modal_title=”Additional Investigation Information” show_footer=”off” _builder_version=”4.18.0″ _module_preset=”0e4bb1fa-d312-42c0-b873-269eda7f61b5″ global_module=”10115″ saved_tabs=”all” global_colors_info=”{}”]<\/p>\n Imaging and laboratory investigations are not required<\/strong> to assist with clinical OA diagnosis<\/strong> of typical presentation. A clinical diagnosis is sufficient to begin care planning<\/strong> and treatment of OA and clinical presentation, in combination with shared decision-making, should guide the ongoing management of OA. Imaging findings may not always match the individual\u2019s symptoms, and do not predict the response to treatment.<\/p>\n If the screening questions have indicated further investigation is required or if the diagnosis is uncertain, then consider imaging. The assessing clinician can begin with preliminary imaging and proceed to advanced imaging only if indicated.<\/p>\n\n
KEY RESOURCES<\/strong><\/span><\/span><\/h3>\n
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WHEN TO REFER<\/h1>\n
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TRIAL CONSERVATIVE CARE<\/h1>\n
STARTING & COMPLETING REFERRAL<\/h1>\n
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SURGICAL CARE PATH<\/h1>\n
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SURGICAL CANDIDACY<\/h1>\n
ONGOING MANAGEMENT<\/h1>\n
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![\"Shared](\"https:\/\/toolkit.albertaboneandjoint.com\/osteoarthritis\/wp-content\/uploads\/shared-decision-making-300x168.png\")