Objectives

Effective analgesia after total knee arthroplasty (TKA) improves patient satisfaction, mobility and expedites discharge. This study assessed whether continuous femoral nerve infusion (CFNI) was superior to a single-shot femoral nerve block in primary TKA surgery completed under subarachnoid blockade including morphine.

Introduction: Waiting times for first specialist assessments (FSA’s) are excessively long and a significant number of patients have to wait for more than six months. Less than 30% of the patients referred to an orthopaedic clinic will require surgery. This means that some patients have to wait over six months to be told that there is no surgical solution to their problem.

Aim: To evaluate the role of ‘paper only’ assessments for FSA’s in orthopaedics.

Method: One hundred GP referrals were selected randomly and all available investigations (mostly x-rays) were retrieved. The referral letters were retyped and the x-rays processed in order to eliminate all identifying information. A pro forma was used to record data including quality of referral letter, clinical information, investigations and recommendation to the GP in the form of a mock letter.

Subsequently the patients were booked into routine orthopaedic clinics without prior knowledge of the investigator and after the face-to-face assessment a letter to the GP was generated. Correlation between the mock and real GP letter was carried out in all cases.

Results: The majority of referrals were for back pain and hip or knee problems. The quality of the referrals was satisfactory with only a small percentage of poor and excellent letters. Pain and physical disability information was more consistently available compared with data on social disability. The X-rays when appropriate were available in most cases.

The correlation between the mock and real letter was outstanding and in over 90% of the cases the face to face assessment did not alter the outcome of the paper assessment.

Conclusions: Paper assessments in orthopaedics are an effective and safe alternative to face-to-face assessments as long as the clinical information in the referral letter is appropriate. This allows for timely advice to the GP and a reduction in waiting times for specialist assessments. This new assessment method is particularly appropriate for conditions that do not benefit from surgery.