Medicine in orthopaedics: a role for the rheumatologist?

In a seven-month period 102 patients admitted for elective orthopaedic surgery (total hip replacement for more than 50%) were referred for a medical opinion, and more than 70% were seen preoperatively. Twenty-nine patients were considered unfit for operation for a variety of different reasons, but after suitable treatment surgery was possible for most of this group. General practitioners and surgeons alike provided insufficient information prior to admission, and this resulted in postponement of operations. A wide variety of conditions was seen pre- and post-operatively, and a very high level of diagnostic criticism was maintained by orthopaedic junior staff but management of certain metabolic conditions was poor. As the number of elderly patients requiring joint replacement surgery increases, great care must be exercised in preoperative assessment in order to maintain an economic service. Combined orthopaedic and rheumatology consultation might be advantageous.