Refer for emergency assessment 

Direct to an emergency department for:

  • Acutely septic prosthetic joint
  • Joint dislocation
  • Knee extensor mechanism rupture
  • Locked knee where the joint cannot be moved at all 
  • Open injury with possible tendon or joint involvement
  • Patients with acutely painful, hot, swollen joint especially if febrile
  • Suspected acute bone infection
  • Suspected fracture, or fracture requiring manipulation or operation.

Criteria for referral to public hospital specialist clinic services

  • Existing total knee replacement with new pain, loosening or other concern
  • Suspected malignancy of knee, leg or calf
  • Other chronic knee conditions including: 
    • anterior knee pain
    • chronic anterior cruciate ligament (ACL) tear
    • knee ligamentous injury or instability
    • loose body, unstable osteochrondral fragment, osteochronditis dissecans (OCD)
    • meniscal injury or pathology with intermittent mechanical symptoms (locking, clicking, catching)
    • recurrent patellar dislocation 
    • spontaneous osteonecrosis of the knee.

Information to be included in the referral

Information that must be provided

  • Reason for referral and expectation, or outcome, anticipated by the patient, or their carer, and the referring clinician from referral to the health service
  • Description of joint affected and onset, nature and duration of symptoms
  • Findings on physical examination, where relevant include results of clinical ligament and meniscus tests completed 
  • How symptoms are impacting on daily activities including impact on work, study or carer role and level of sleep disturbance
  • Details of previous medical and non-medical management including the course of treatments and outcome of treatments 
  • If referral relates to previous joint replacement description of new pain, limp or sounds
  • If referral relates to injury detail: date, mechanism, severity, recurrence and evolution of injury
  • If referral relates to infection or inflammation provide full blood examination and inflammatory marker results (erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP))
  • x-ray of two views of the affected knee: weight bearing anteroposterior (AP) and lateral
  • Details of any previous joint surgery including when and where procedures were performed.

Provide if available

  • Results from most recent hip and knee questionnaire, or similar symptom burden questionnaire 
  • Current and complete medication history (including non-prescription medicines, herbs and supplements and recreational or injectable drugs)
  • MRI where there is ligament damage 
  • Recent HbA1c results if patient has diabetes 
  • History of smoking
  • Statement about the patient’s interest in having surgical treatment if that is a possible intervention
  • If the person identifies as an Aboriginal and Torres Strait Islander
  • If the person is part of a vulnerable population.

Additional comments

The Summary and referral information lists the information that should be included in a referral request.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Ultrasound imaging is not indicated. 

There are other statewide referral criteria that include reference to knee pain:

Vulnerable populations include:

  • people from culturally and linguistically diverse backgrounds
  • older Australians
  • carers of people with chronic conditions
  • people experiencing socio-economic disadvantage
  • people living in remote, or rural and regional locations
  • people with a disability
  • people with mental illness
  • people who are, or have been, incarcerated.

Vulnerable patient groups also include terminally ill patients, patients with experiences of family violence, in out-of-home care, foster care and those in state care.

Referral to a public hospital is not appropriate for

  • Recurrent patellar dislocation where non-surgical treatment modalities have not been trialled.