Orthopaedics
The Royal Perth Hospital (RPH) Orthopaedic Service provides a consultation service for adult patients referred with all orthopaedic conditions. This includes acute and follow up trauma, joint replacements, revision of failed joint replacements, and other general orthopaedic procedures.
If you have an orthopaedic problem, please see your General Practitioner, or for emergencies please go to your nearest Emergency Department.
Information for referring practitioners
Urgent Orthopaedic Outpatient Referrals
For urgent outpatient appointment referrals or advice, referring practitioners can telephone 9224 2244 and request to speak to the on-call Orthopaedic Registrar.
Routine outpatient referrals
With a high demand for new, non-urgent Orthopaedic appointments at RPH, the Department of Orthopaedics requests that GPs consider appropriate conservative management options where possible. Where referral to RPH is still required, please include a copy of all imaging reports and details of any conservative management trialled to date.
Patients may be referred for routine assessment to the Outpatient Clinic via Central Referral Service using standard outpatient referral forms (external link) with all additional information attached.
Central Referral Service (external link)
GPO Box 3462
Midland WA, 6056
Or fax to 1300 365 056.
Visiting Medical Practitioners
East Metropolitan Health Service provides access to the RPH Public surgical list to some specialists who practice privately at Armadale Health Service.
This Visiting Medical Practitioners (VMP) model offers an alternative pathway for patients requiring surgical review. Referral to one of the VMPs may result in shorter waiting times for your patient.
The initial consultation may incur a cost to the patient, but where surgery is required, the specialist can provide this in a non-tertiary public hospital (where clinically appropriate) at no cost to the patient.
If you wish to refer your patients to one of our VMP clinicians please send a named referral directly to the desired clinician from the lists on the Armadale Health Service website (external link).
Condition specific referral criteria
Download the Ankle / Hindfoot Arthritis referral criteria (PDF 130KB).
Indications for urgent referral
- Increase swelling / redness or signs of infection – immediate referral to the Emergency Department.
Criteria for specialist referral via CRS
- Pain around the ankle.
- Associated swelling and deformity.
- Difficulty in walking.
- Unsuccessful trial of “Required GP management” (see below).
Information required for referral
All referrals must include comprehensive medical history, relevant test results and a detailed summary of treatment to date.
If required, diabetic control with a targeted HbA1C of < 7.5% (or 58 mmol/mol) and documentation of weight loss management for patients with a BMI > 40.
Also required:
- Detailed history of the pain, deformity and swelling (location, severity, type, aggravating and relieving factors).
- Range or movement of the joint.
- Associated medical conditions.
- Any previous treatments.
Investigations required for referral
- Full weight bearing foot x-rays.
Optional: Ultrasonography to identify tendon/ligament pathology.
Required GP Management
- Referral to physiotherapy and/or podiatry unless clearly requires surgery.
- Orthotics – arch supports/soft heel pads.
- Supportive footwear.
- Analgesics and anti-inflammatory medications (unless contraindicated).
- Ultrasound guided steroid injection (unless contraindicated).
Download the Charcot Neuroarthropathy referral criteria (PDF 160KB).
Indications for urgent referral
- Suspected or confirmed Acute Charcot Neuroarthropathy (e.g. red, hot and/or swollen) – referral to the Multi-disciplinary Foot Ulcer Clinic or tertiary hospital Podiatry Clinic.
- Increase swelling / redness or signs of infection – immediate referral to the Emergency Department.
- Acute or Chronic (stable) Charcot Neuroarthropathy with associated foot ulceration – referral to Multi-disciplinary Foot Ulcer Clinic or tertiary hospital Podiatry Clinic.
Criteria for specialist Orthopaedic referral via CRS
- One of the following:
- Significant foot deformity due to Chronic (stable) Charcot Neuroarthropathy; or
- Foot pain not responding to conservative management (orthoses/orthopaedic footwear) on background of Chronic (stable) Charcot Neuroarthropathy; or
- Recurrent foot ulceration or significant pressure areas due to foot deformity secondary to Charcot Neuroarthropathy.
- Unsuccessful trial of “Required GP management” (see below).
Information required for referral
All referrals must include comprehensive medical history, relevant test results and a detailed summary of treatment to date.
Diabetic control with a targeted HbA1C of < 7.5% (or 58 mmol/mol) and documentation of weight loss management for patients with a BMI > 40.
Also required:
- Detailed history of the pain, deformity and swelling (location, severity, type, aggravating and relieving factors).
- Associated medical conditions.
- Any other associated injuries.
- Any previous treatments.
Investigations required for referral
- Full weight bearing x-rays of foot +/- ankle.
Required GP management
For suspected or confirmed acute Charcot Neuroarthropathy: Urgent referral to Tertiary Hospital Podiatry Clinic is recommended and GP to advise non-weight bearing.
For chronic/stable Charcot Neuroarthropathy: Accommodative orthotics, orthopaedic/custom footwear with rocker sole or CROW Boot.
Download the Claw Toe / Hammer Toe referral criteria (PDF 160KB).
Indications for urgent referral
- Signs of infection or ulceration – immediate-referral to the Multi-disciplinary Foot Ulcer Clinic.
- Signs of ischaemia, sepsis or ascending cellulitis – refer to the Emergency Department.
Criteria for specialist referral via CRS
- Lesser toe deformity +/- corns and callosities with at least one of the following symptoms:
- Pain due to rubbing and corns.
- Difficulty in wearing closed shoes.
- Unsuccessful trial of “Required GP Management” (see below).
Information required for referral
All referrals must include comprehensive medical history, relevant test results, and a detailed summary of treatment to date.
Diabetic control with a targeted HbA1C of < 7.5% (or 58 mmol/mol) and documentation of weight loss management for patients with a BMI > 40.
Also required:
- History of the pain, deformity and swelling (location, severity, type, aggravating and relieving factors).
- Functional limitations.
- Any previous treatments (e.g. Orthotics).
- Any previous surgery.
- Associated medical conditions.
- Problems with footwear.
Investigations required for referral
- Full weight bearing foot x-rays isolating toe/s.
Required GP Management prior to referral
- Referral to community podiatry.
- Extra depth footwear.
- Orthotics / spacer / toe props.
- Analgesia / Anti-inflammatory medicines (unless contra-indicated).
Download the Flat feet (Pes Planus) referral criteria (PDF 160KB).
Criteria for specialist referral via CRS
- Flattening of the medial longitudinal arch of the foot +/- pain.
- Unilateral; or
- Acquired (flattening of the arch in adulthood); or
- Rigid (loss of normal hind foot inversion/ eversion); or
- Bony prominence on the medial border of the foot.
- Unsuccessful trial of “Required GP management” (see below).
Information required for referral
All referrals must include comprehensive medical history, relevant test results and a detailed summary of treatment to date.
Diabetic control with a targeted HbA1C of < 7.5% (or 58 mmol/mol) and documentation of weight loss management for patients with a BMI > 40.
Also required:
- History of the pain, deformity and swelling (location, severity, type, aggravating and relieving factors).
- Functional limitations.
- Unilateral or bilateral.
- Acquired (adult) or developmental (childhood).
- Rigid or flexible hind foot movement.
- Progression of deformity (is it worsening?).
- Any previous treatments.
- Any previous surgeries.
Investigations required for referral
- Full weight bearing foot x-rays.
- Ultrasound to examine Tibialis Posterior tendon.
Required GP Management prior to referral
- Referral to community podiatry.
- Supportive footwear (usually lace up) +/- foot orthotics arch supports with medial heel wedge.
- Analgesia / Anti-inflammatory medicines (unless contra-indicated).
Download the Hallux Rigidus / 1st MTP Joint Arthritis referral criteria (PDF 130KB).
Indications for urgent referral
- Signs of infection or ulceration – immediate-referral to the Multi-disciplinary Foot Ulcer Clinic.
- Signs of ischaemia, sepsis or ascending cellulitis – refer to the Emergency Department.
Criteria for specialist referral via CRS
- Pain / swelling in the first metatarsophalangeal joint.
- Unsuccessful trial of “Required GP management” (see below).
Information required for referral
All referrals must include comprehensive medical history, relevant test results and a detailed summary of treatment to date.
Diabetic control with a targeted HbA1C of < 7.5% (or 58 mmol/mol) and documentation of weight loss management for patients with a BMI > 40.
Also required:
- Detailed history of the pain, deformity and swelling (location, severity, type, aggravating and relieving factors).
- Functional limitations.
- Any previous treatments (e.g. Orthotics).
- Any previous surgery.
- Associated medical conditions.
Investigations required for referral
- Full weight bearing foot x-rays.
Required GP Management prior to referral
- Referral to community podiatry.
- Orthotics, footwear with rigid soles, medial heel wedge.
- Analgesia / Anti-inflammatory medicines (unless contra-indicated).
Download the Hallux Valgus / Bunions referral criteria (PDF 160KB).
Criteria for specialist referral via CRS
- One of the following:
- Bunion deformity +/- pain over the bunion; or
- Deformity of lesser toes +/- corns and callosities; or
- Limitation in daily / recreational activities; or
- Difficulty in wearing closed shoes.
- Unsuccessful trial of “Required GP management” (see below).
Please note that cosmesis alone is not an indication for surgical management.
Information required for referral
All referrals must include comprehensive medical history, relevant test results and a detailed summary of treatment to date.
Diabetic control with a targeted HbA1C of < 7.5% (or 58 mmol/mol) and documentation of weight loss management for patients with a BMI > 40.
Also required:
- Detailed history of the pain, deformity and swelling (location, severity, type, aggravating and relieving factors).
- Functional limitations.
- Any previous treatments (e.g. Orthotics).
- Any previous surgery.
- Associated medical conditions.
- Problems with footwear.
Investigations required for referral
- Full weight bearing foot x-rays.
Required GP Management prior to referral
- Referral to community podiatry.
- Appropriate footwear.
- Orthotics, footwear with rigid soles, medial heel wedge.
- Analgesia / Anti-inflammatory medicines (unless contra-indicated).
Download the Metatarsalgia / Morton’s Neuroma referral criteria (PDF 210KB).
Criteria for specialist referral via CRS
- One of the following:
- Pain in the forefoot; or
- Pain in the toes worsened by closed / tight shoes; or
- Pain under the metatarsal heads (ball of foot), feels like a stone, worse when barefoot
- Unsuccessful trial of “Required GP management” (see below)
Information required for referral
All referrals must include comprehensive medical history, relevant test results and a detailed summary of treatment to date.
Diabetic control with a targeted HbA1C of < 7.5% (or 58 mmol/mol) and documentation of weight loss management for patients with a BMI > 40.
Also required:
- History of the pain, deformity and swelling (location, severity, type, aggravating and relieving factors).
- Advice if pins and needles and/or pain in the toes.
- Advice if pain under metatarsals.
- Associated medical conditions (e.g. diabetes).
- Any previous treatments.
Investigations required for referral
- Full weight bearing foot x-rays.
Please note that ultrasonography for Morton’s Neuroma is inaccurate as it leads to false positives.
Required GP Management prior to referral
- Referral to community podiatry.
- Appropriate footwear.
- Orthotics.
- Analgesia / Anti-inflammatory medicines (unless contra-indicated).
Download the Plantar Fasciitis referral criteria (PDF 130KB).
Criteria for specialist referral via CRS
- Pain on the plantar aspect of the heel.
- Unilateral.
- Pain is most severe in the morning or after prolonged sitting.
- Pain becomes worse if barefoot.
- Unsuccessful trial of “Required GP management” (see below).
Information required for referral
All referrals must include comprehensive medical history, relevant test results and a detailed summary of treatment to date.
If required, diabetic control with a targeted HbA1C of < 7.5% (or 58 mmol/mol) and documentation of weight loss management for patients with a BMI > 40.
Also required:
- Detailed history of the pain, deformity and swelling (location, severity, type, aggravating and relieving factors).
- Details of any associated back or joint pain.
- Any history of trauma to the heel.
- Any previous treatments.
- Occupational history.
Investigations required for referral
- Full weight bearing foot x-rays.
Optional: Ultrasonography to identify thickening in plantar fascia.
Required GP Management
- Referral to physiotherapy and/or podiatry.
- Orthotics.
- Stretching exercises of calf and plantar fascia.
- Analgesics and anti-inflammatory medications (unless contraindicated).
- Ultrasound guided steroid injection (unless contraindicated).
This is often a self-limiting disease and will improve in 6 to 24 months from the onset without specific treatment.
All referrals for shoulder impingement / bursitis MUST contain ultrasound and X-ray radiological reports to enable appropriate triaging. If ultrasound-guided sub acromial injections have also been trialled, radiological reports must again be included.
Referral for shoulder impingement / bursitis with no rotator cuff tear on ultrasound and a normal x-ray is only accepted at Royal Perth Hospital with evidence from the referrer of previous unsuccessful conservative management including:
- At least two ultrasound-guided sub acromial injections with local anaesthetic and steroid (unless contraindicated) AND
- 3 months of physiotherapy.
- Ongoing symptoms despite this treatment warrant referral to an orthopaedic surgeon.