

Managing orthopaedic patients with multiple joint pathologies—commonly known as multimorbid orthopaedic patients—can be intricate. These patients often have several co-existing joint issues such as hip osteoarthritis, knee degeneration, and shoulder impingements. Each condition demands attention, but without a clear strategy, care can become disjointed. This post offers a practical guide on coordinating referrals, determining surgical sequencing, and ensuring patient-centred outcomes.
Before any decision-making, having a comprehensive picture of the patient's health is crucial. That means:
This broad view helps set the stage for collaborative care.
Multidisciplinary communication is the backbone of well-orchestrated care. Here’s an effective approach:
Tip: Use shared-care plans and electronic records to ensure everyone knows who’s doing what.
When multiple joints need surgery, deciding which to address first requires careful thought. Here’s a stepwise way:
In practice: For a patient with both hip and knee arthritis, I usually begin with whichever joint impairs walking the most and offers the greatest functional gain.
Q: Can two joint replacements be done in the same hospital admission?
A: Yes, in select cases like bilateral knee replacements. But the increased length of anaesthesia and risk may outweigh benefits. Staging across separate admissions is often safer.
Q: How long should I wait between surgeries?
A: Typically 3–6 months, depending on recovery, medical optimisation, and patient goals. Some patients may benefit from earlier or later intervals.
Q: What if the patient’s medical conditions worsen between surgeries?
A: Reassess prior to each procedure. You may need to delay, modify the plan, or involve specialist input for optimisation.
Q: Does sequencing affect final outcomes?
A: It can—especially when rehab from one surgery influences recovery from another. Proper sequencing facilitates smoother recovery and better long-term function.
Q: Do insurance and cost impact the sequence?
A: Yes—public vs. private system, waiting lists, and concessional status can shape timing. Discuss pragmatic options with patients up front.