Orthopaedics  |  Osteo Knee & Hip Pathway - Patient on Treatment List




Orthopaedics

Osteo Knee & Hip Pathway - Patient on Treatment List

When the patient is accepted for surgery:  

Pre-admission assessment aims to identify any problems that could increase the risk of surgery/anaesthesia or interfere with the patient's recovery after surgery:

  • Lifestyle risks e.g. smoking, excessive alcohol use
  • Obesity
  • Skin sepsis
  • Check urine for infection. A MSU will be requested 2 weeks before surgery
  • Treat bacteruria as well as overt Urinary Tract Infections
  • Undiagnosed or poorly controlled hypertension
  • Undiagnosed or untreated anaemia
  • Undiagnosed or poorly controlled atrial fibrillation
  • Undiagnosed or poorly controlled diabetes mellitus
  • Undiagnosed or poorly controlled congestive heart failure
  • Undiagnosed or poorly controlled ischaemic heart disease
  • Poor oral health
  • Poor cognitive function (low MMSE or Abbreviated Mental Test Score)
  • Other problems e.g. renal impairment, liver impairment, obstructive sleep apnoea, and cervical spinal spondylosis/arthritis

The GP is involved as necessary to manage any outstanding issues that may delay surgery.

GP ongoing review:

  • GP checks that the patient understands the patient journey e.g. expected number of days in hospital
  • Support Net referral if necessary
  • An MSU will be requested 2 weeks before surgery with an alert letter and copy of result to the GP. GPs please treat bacteruria as well as overt Urinary Tract Infections
  • Pain control. Conservative management of hip osteoarthritis
  • Note that NSAIDs and aspirin can be continued up to and including day of surgery
  • Red flags that trigger additional action e.g. repeat Xray or notification of treating Orthopaedic Surgeon by referring the patient again (Link to the Referral form)

Specific concerns:

  • Overweight patients (BMI > 35): send dietitians referral to- L.Chee@temanutoroa.org.nz or fax to- 07 571 2027
  • Underweight patients (BMI < 20): refer to dietitian at BOPDHB
    • The target for joint replacement surgery is a BMI of < 40
    • Dietitian referral
    • Exercise prescription (Green prescription)
    • Dietitian referral
  • Smoking cessation (Quitline)


Montreal Cognitive Assessment (MoCA) is preferred in suspected dementia:

The Montreal Cognitive Assessment (MoCA) was designed as a rapid screening instrument for mild cognitive dysfunction. It assesses different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. Time to administer the MoCA is approximately 10 minutes. The total possible score is 30 points; a score of 26 or above is considered normal.

 



Last updated : Wednesday, January 31, 2018
Next review date : Thursday, January 31,2019


Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.