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Orthopaedic and Trauma Hip and Knee outpatient services in Central Adelaide

The Central Adelaide Local Health Network (CALHN) Orthopaedic and Trauma Service provides inpatient and outpatient care for patients living in the Central Adelaide Local Health Network (CALHN) area who suffer from hip and knee problems including, but not limited to; osteoarthritis, inflammatory arthritis, post-traumatic arthritis, developmental dysplasia of the hip/hip deformity, avascular necrosis, soft tissue injuries in the knee including cruciate ligament injury and meniscal tears. We also specialise in complex revision arthroplasty and hip preservation surgery in young adults.

Services are also provided to patients referred from rural and remote areas within South Australia and the Northern Territory on referral from the Royal Darwin Hospital or Alice Springs Hospital. In addition, CALHN also receives referrals from other local health networks (LHNs) for complex hip and knee disorders, adolescent hip disorders and complex revision surgery and infected joint replacement.

Children are usually managed by paediatric specialists, with referral to the Women’s and Children’s Hospital.

Contact details – outpatients

Royal Adelaide Hospital (RAH) 

  • Clinic fax (for referrals): (08) 7074 6247
  • For all appointments: enquiries and new case appointments: (08) 1300 153 853
  • Review / change of appointments: (08) 1300 153 853

The Queen Elizabeth Hospital (TQEH)

  • Clinic fax (for referrals): (08) 8222 7244
  • For all appointments: enquiries and new case appointments: (08) 8222 7010
  • Review / change of appointments:(08) 8222 7010

Appointment location – outpatients

Royal Adelaide Hospital (RAH)
Orthopaedic Outpatients, Level 3 
Royal Adelaide Hospital, Port Road, Adelaide SA 5000

The Queen Elizabeth Hospital (TQEH)
Orthopaedic Outpatients, Ground floor, Area 3, 
The Queen Elizabeth Hospital, Woodville South, Adelaide SA 5011

Services and clinics available

Services provided are:

  • outpatient clinic consultations for diagnosis and management
  • post-operative reviews
  • virtual clinic for reviews from country areas and nursing home
  • inpatient consultations
  • inpatient admission

Orthopaedic outpatients – hip and knee

The objective of an orthopaedic outpatient appointment is to provide an assessment of the patient, form a diagnostic opinion (which may require further investigation), and outline a management plan.

Management of hip and knee conditions may involve non-operative measures or operative intervention, depending on the type and severity of the condition. Non-operative measures may involve education and guidance regarding the use of simple analgesics, referral to physiotherapy for strengthening exercises and / or lifestyle modifications including weight loss, physical activity and the use of aids or supports. Fractures are monitored at necessary intervals until they are healed or further treatment is required.

The intention of the service is to provide acute intervention with a view to transferring the patients care back to their general practitioner as early as possible following intervention.

To enable close monitoring of all patients who have had joint replacements, the department of orthopaedics and trauma has undertaken an extensive program of patient documentation. This involves scheduled reviews of patients with joint replacements in-situ either in person or via a virtual clinic with or without radiographs dependant on patient complexities and how many years have passed post-surgery.

Clinics are run in-line with individual consultants and a team of registrars. Patients are generally seen by a consultant medical officer, either directly or in an overseeing role following inputs from a registrar and / or a specialist nurse or allied health professional depending on the reason for referral and the patient’s ongoing care needs.

RAH

Day Clinics (all at RAH) Doctors Conditions seen
Monday Trauma 1
Trauma 2
Mr Daniel Mandziak
Mr Chien-Wen Liew
Hip and knee osteoarthritis  
Sports knee (soft tissue injury)  
Joint replacement review  
Fracture management  
Review of Internal fixation
Tuesday Trauma 2
Orthopaedics 2
Mr Kevin Angel  
Mr Jason Ward  
Mr Justin Webb  
Mr Justin Munt
Hip and knee osteoarthritis  
Sports knee (soft tissue injury)  
Joint replacement review  
Fracture management  
Review of Internal fixation
Wednesday Orthopaedics 1
Orthopaedics 2
Mr Francis Ghan  
Mr Brian Wallace  
Mr Robert Baird  
Mr Daniel Mandziak  
Mr Richard Clarnette  
Associate professor Anthony Pohl  
Arthroplasty fellow (changes yearly)
Hip and knee osteoarthritis  
Sports knee (soft tissue injury)  
Joint replacement review  
Fracture management  
Review of Internal fixation
Thursday Orhtopaedics 1
Trauma 1
Professor Don Howie   
Associate professor Bogdan Solomon  
Mr Robert Fassina
Hip and knee osteoarthritis  
Sports knee (soft tissue injury)  
Joint replacement review  
Fracture management  
Review of Internal fixation
Young hip conditions
Friday Young hip clinic (bi-annual clinic only) Professor Don Howie  
Associate professor Bogdan Solomon  
Arthroplasty fellow (changes yearly)  
Women’s and Children Hospital’s orthopaedic consultant/s
Young hip conditions

 

TQEH

Day Clinics (all at TQEH) Staff Conditions seen
Monday Orthopaedics 1  
Orthopaedics 2
Mr Will Duncan  
Dr Nancy Cullen  
Mr Chi Gooi
Hip and knee osteoarthritis  Sports knee (soft tissue injury)  Joint replacement review  Fracture management  Review of internal fixation
Tuesday Orthopaedics 1   
Fracture   
Orthopaedics 2      
Arthroplasty referral assessment clinic (ARAC)
Mr Collie Begg  
Mr Nick Pourgiezis  
Mr Ahmed Bajhau  
Ms Lesley Thomas (nurse practitioner)   
Physiotherapist
Hip and knee osteoarthritis  
Sports knee (soft tissue injury)  
Joint replacement review  
Fracture management  
Review of internal fixation  
Hip and knee osteoarthritis assessment and management plan 
Wednesday  -  -  -
Thursday Fracture   
Orthopaedics 1   
Orthopaedics 2
Mr John van Essen  
Mr Nick Pourgiezis  
Mr David Campbell  
Mr Ahmed Bajhau  
Mr Peter Lewis  
Mr Chi Gooi  
Dr Nancy Cullen
Hip and knee osteoarthritis  
Joint replacement review  
Fracture management  
Review of internal fixation
Friday Orthopaedics 1 Mr Collie Begg  
Dr Nancy Cullen
Hip and knee osteoarthritis   
Sports knee (soft tissue injury)   
Joint replacement review

Referral process

Immediate referral process
Where consultation is 'same day' urgent, the on-call orthopaedic registrar should be contacted via the RAH switchboard (08) 7074 0000 or TQEH switchboard (08) 8222 6000 to discuss the patient.

If the condition is life or limb -threatening, the patient should be sent to the nearest emergency department.

Less urgent referrals
Preferred method of referral is by fax or letter. All referrals must be in writing. 
Please fax referrals to: RAH (08) 7074 6247 or TQEH (08) 8222 7244

Non-urgent referrals will be allocated to the next available appointment. Non-urgent referrals will incur a wait. The waiting time for appointment will vary and be dependent on the demand for this service and the medical urgency of the patient’s condition.

Some hip and knee problems are not considered as high priority as others (see eligibility and referral criteria) and may wait a longer time for an appointment. Please consider other options and do not refer to multiple providers regarding the same presenting complaint.

Should changes occur to a patient’s medical condition during the waiting time for an appointment, referrers should send updated clinical information and where appropriate, contact the Orthopaedic registrar via the RAH switchboard on (08) 7074 0000 or TQEH switchboard (08) 8222 6000.

Clinical features indicative of potentially serious pathology

General hip and knee
Hip fracture – hip pain associated with history of trauma
Malignancy – hip or knee symptoms associated with red flag symptoms such as night pain,  anorexia/weight loss, malaise +/- history of cancer
Septic joint – severe pain, joint swelling and systematically unwell patient
Peri-prosthetic fractures – severe pain, inability to mobilise
Post-operative patients
Elective surgery
Symptoms - severe pain, swelling, increased local temperature, history of trauma / injury to relevant site post-surgery
Infection - wound related issues, cellulitis, swelling, systemically unwell patient
Prosthetic hip dislocation
DVT/PE – calf swelling, pain, tender to touch – for GP investigation and if positive, discuss with orthopaedic registrar on-call via the RAH switchboard on (08) 7074 0000 or TQEH switchboard (08) 8222 6000 regarding anti-coagulation trauma
Compartments Syndrome – pain excessive of that expected for injury, swelling
Infection - wound related issues, cellulitis, swelling, systemically unwell patient
If concerned about any of the above symptoms, please contact the orthopaedic registrar on-call via the RAH switchboard (08) 7074 0000 or TQEH switchboard (08) 8222 6000 to discuss the patient. If the condition is life or limb -threatening, the patient should be sent to the nearest emergency department.

Referrals unlikely to be offered an appointment

The Orthopaedic and Trauma Service does not provide second opinions for patients that have been previously assessed or treated by an orthopaedic specialist from an institution that has the ability to provide an in-house second opinion. Referrals for second opinions for young hip disorders in adults and adolescents will be accepted from an orthopaedic surgeon from another institution.

The Orthopaedic and Trauma Service does not provide a service to patients that are known to another institution for a particular problem. We suggest that if a patient has had a hip or knee problem assessed and / or treated at an institution before, that they be referred back to that institution for continuity of care and adequate access to investigations and information already collected by that institution.

The Orthopaedic and Trauma Service does not provide a service to compensable patients unless they have been admitted via the emergency department in an emergency situation. This includes motor vehicle accidents, work cover injury, Department of Veteran Affairs, other third party or public liability claims. In compliance with the SA Health Directive the ‘Referral to Specialist Outpatient Services Guideline’ states that 'A compensable patient is not eligible to access publicly funded services as their compensation covers the cost of private medical expenses'.

Transfer of care from another specialist may be accepted if the patient’s surgical requirements are too complex or the patient’s medical condition/s means that the surgery would be safer performed in a tertiary institution.

Referrals from other outpatient clinics in the RAH / TQEH may not be accepted unless specific orthopaedic input is required for the condition for which the patient is already attending a hospital outpatient clinic.

For further information on referral processes see the outpatient referral process page.

Alternate care options / health information for low priority conditions while waiting for an appointment

Dependent on the type and severity of the hip and / or knee condition, there may be a lengthy wait for some patients to be seen in the orthopaedic outpatient clinics.

In most cases, the key to appropriate management is a detailed history and examination. Options for obtaining further information regarding various hip and knee conditions and to provide guidance for assessment, investigations and management are listed under the orthopaedic clinical information sheets below.  

Other clinical resources to consider:

  • Inflammatory arthritis in the hip and / or knee joint/s: Rheumatology clinics RAH or TQEH
  • Lower back pain which radiates to hip and / or knees: Spinal Assessment Clinic RAH
  • Severe non-inflammatory pain syndromes: Pain Clinic RAH

Post discharge guidelines and information

If the patient or their general practitioner is concerned about a post-operative patient (see clinical information sheets and table of clinical features indicative of potentially serious pathology) and orthopaedic assessment is required earlier than planned, a phone call to the RAH Orthopaedic outpatients department on (08) 1300 153 853 or TQEH Orthopaedic outpatients department on (08) 8222 7010 will allow this to be discussed with one of the orthopaedic nurses. After hours, the on-call orthopaedic registrar should be contacted via the RAH switchboard (08) 7074 0000 or TQEH switchboard (08) 8222 6000 to discuss the patient.

If a joint replacement patient is experiencing any issues or has any questions or concerns regarding post-operative care of their joint replacement, they can call:

  • RAH Joint Replacement Nursing Service via the switchboard on (08) 7074 0000, pager #1731 or pager #1942, or
  • The TQEH orthopaedic nurse practitioner on via the switchboard on (08) 8222 6000, pager #6778.

Patients whose orthopaedic condition has stabilised or resolved and for whom no further appointment has been made will be formally discharged. If orthopaedic assessment is required again, a new referral should be faxed to the RAH Orthopaedic outpatient department on (08) 7074 6247 or the TQEH Orthopaedic outpatient department on (08) 8222 7244.

Orthopaedic and Trauma Service – hip and knee priorities based on clinical urgency as displayed below:

Priority Examples
(not an exhaustive list)
Referral process
Immediate
Orthopaedic emergencies with threat to a limb.
Acute orthopaedic problem where admission is required.
Direct to an emergency department.
Fracture (pelvic/femur/tibia/fibula/patella)    
Peri-prosthetic fracture  Severed limbs  
Significant soft tissue injury   
Compartments Syndrome   
Dislocation of the hip or knee    
Open or discharging wound post-operatively   
Septic arthritis
Must be discussed with the on-call orthopaedic registrar via RAH switchboard on (08) 7074 0000 or TQEH switchboard on (08) 8222 6000.   
f the condition is life or limb-threatening, the patient should be sent to the nearest emergency department.
Urgent
Condition has the potential to require more complex or emergency care if assessment is delayed.    Must be discussed with the on-call orthopaedic registrar via RAH switchboard on (08) 7074 0000 or TQEH switchboard on (08) 8222 6000 to obtain appropriate prioritisation.
Condition has the potential to have significant impact on quality of life if care is delayed.
Suspicion of infected prosthesis – recent surgery    Failed internal fixation      Locked knee (inability to fully extend)    Osteomyelitis Must be discussed with the on-call orthopaedic registrar via RAH switchboard on (08) 7074 0000 or TQEH switchboard on (08) 8222 6000 to obtain appropriate prioritisation.
Semi-urgent
Condition is unlikely to require more complex care if assessment is delayed.
Condition has the potential to have some impact on quality of life is care is delayed.
Suspicion of prosthetic loosening or prosthesis associated pain, decrease in function    
Avascular necrosis of the femoral head    
Collapse of the femoral head     
Severe Osteoarthritis of the hip with signs of protrusio
Referrals should be faxed to the RAH on (08) 7074 6247 or the TQEH on (08) 8222 7244.
Intermediate
Condition is unlikely to deteriorate quickly.
Condition is unlikely to require more complex care if assessment is delayed.   
Developmental dysplasia of the hip   
Femoroacetabular Impingement   
Perthes Disease    
Slipped capital femoral epiphysis  
Referrals should be faxed to the RAH on (08) 7074 6247 or the TQEH on (08) 8222 7244.
Non-urgent
Low priority
Osteoarthritis of the hip or knee   
Post-traumatic arthritis   
Soft tissue injury of the knee including meniscal tear, cruciate ligament or collateral ligament injury or cartilage damage   
Trochanteric Bursitis – if non-responsive to treatment after 3 months and symptomatic
Referrals should be faxed to the RAH on (08) 7074 6247 or the TQEH on (08) 8222 7244.
Note:
It is important to note these guidelines indicate what is clinically desirable, not what is always feasible in terms of delivery which is dependent on size and staffing of the hospital department.

Orthopaedic and Trauma Service – Hip and Knee clinical information sheets

The following information sheets about presentations commonly seen in orthopaedic outpatients (hip and knee related) detail the minimum information required for assessing a referral under the headings of: eligibility, priority, differential diagnosis, clinical information and investigations required, pre-referral management strategies and discharge criteria.

 

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