Synopsis
Make referral and operative decisions from quality-of-life impact, failed or unsuitable non-operative care, anatomy, goals and individual risk; explain implant choices and optimisation without inequitable numerical or demographic barriers.
- Refer when joint pain, stiffness, deformity or reduced function substantially affects quality of life and non-surgical management is ineffective or unsuitable.
- Use clinical assessment and shared decision-making; do not require a numerical severity score and do not exclude referral solely because of age, sex, smoking, comorbidity, overweight or obesity.
- Confirm that symptoms arise from the target joint and that reasonable education, exercise, weight support and safe medication have been offered or are unsuitable; this is not a rigid checklist that prolongs avoidable disability.
Key red flags
A hot joint, draining sinus, persistent wound or unexplained raised inflammatory markers requires infection investigation before primary implantation.
Investigation priorities
Measure symptom impact, goals and response or unsuitability of non-operative care.
Management branches
Symptoms substantially affect quality of life and evidence-based non-operative care is ineffective or unsuitable.
- Confirm the likely pain-generating joint and document function, goals and previous treatment.
- Discuss replacement and continued non-operative options and refer without a numerical-score or demographic barrier.
Key medicines
Perioperative antimicrobial prophylaxisGive the hospital's current primary hip or knee replacement prophylactic antibiotic at the full weight-, allergy- and renal-adjusted dose within the protocol time before incision, record administration, and repeat intra-operatively only when the specific protocol duration or blood-loss criterion is met.
Venous-thromboembolism prophylaxisPrescribe the exact mechanical and pharmacological regimen from the current hospital elective-arthroplasty and NICE pathway, starting and continuing at the procedure-specific times after balancing thrombosis, neuraxial and bleeding risk.