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Only after a surgeon has conducted a physical examination, can they determine if it’s safe and appropriate to proceed to surgery.
Given the risk of serious complications with any form of surgery, a hip replacement is only undertaken as the last resort and after all non-surgical treatments have been exhausted without any functional improvement.
Just because you have hip pain does not mean you require a hip replacement or to see a surgeon. It has been estimated that up to 80% of patients referred for a hip replacement do not need a hip replacement yet.
Surgeons don’t judge patients, they judge referral letters from family physicians to see if the patient has exhausted all non-surgical treatment options and meets their criteria for surgery.
Below is a checklist of what surgeons commonly look for in a referral letter from your physician.
If your letter does not include all items in the checklist, you can expect that your referral will likely be denied or deferred and you will not be offered an appointment.
One of the most common reasons surgeons reject a referral is because they believe there are other non-surgical treatment options that have not been tried yet.
Research conducted by the University of British Columbia Department of Orthopaedics (2013) (1), concluded that;
“More than three-fourths of patients referred by primary-care physicians did not need to see a surgeon and were able to be managed by an experienced orthopaedic physiotherapist. This triage model could have considerable impact on orthopaedic wait times in Canada by minimizing unnecessary referrals; the model could also promote timely and conservative management of non-surgical conditions by physiotherapists,”
In this study, experienced orthopaedic physiotherapists were found to be 4x better, than family physicians and emergency room physicians, at identifying patients who required surgery. This is why surgeons commonly look for a letter from an experienced physiotherapist included with your physician’s referral letter.
To ensure your referral letter is not missing information, don’t be afraid to ask your physician to for a copy of your referral letter before they send it to a surgeon.
#1 A hip x-ray report from within the last 12 months that indicates moderate to severe joint degeneration that correlates with the location of your hip pain (i.e. “bone-on-bone”, “severe joint space narrowing”)
#2 A statement from your physician describing and confirming that you have tried ALL appropriate pain management options, without any improvement in your hip function. (i.e. over-the-counter pain medications, prescription oral and topical pain medications, joint injections, assistive devices).
#3 An attached letter from an experienced orthopaedic physiotherapist confirming they believe you have participated in a supervised rehab neuromuscular exercise program for three months without any improvement in your hip function and they endorse a surgical consult for a possible hip replacement.
#4 A statement from your physician confirming that you have attempted a weight reduction program in the past year without any improvement in your hip function.