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OET Physiotherapy · Referral Letter

Physiotherapy Referral Letter: Knee Osteoarthritis to Orthopaedics

A physiotherapist refers a patient with knee osteoarthritis who has not improved with a full course of exercise therapy to an orthopaedic surgeon.

Task

Using the information in the case notes, write a letter of referral to Mr John Fraser, Orthopaedic Surgeon, requesting assessment for further management.

Case notes

  • Mrs Grace Adeyemi, 66, left knee osteoarthritis confirmed on X-ray (severe medial joint space narrowing).
  • 12 weeks of supervised exercise and weight-management advice; attended 11 of 12 sessions; lost 4 kg.
  • Pain at rest and at night now 7/10 (was 5/10 at start). Walking tolerance reduced from 30 to 10 minutes.
  • Knee flexion 0–95°; fixed flexion deformity 5°; quadriceps strength improved.
  • Analgesia: regular paracetamol and topical NSAID, minimal benefit.
  • Lives with husband; stopped her volunteer work at a library because of pain. Has a grandchild’s wedding in 3 months.

Try it yourself first: five minutes to plan, 40 minutes to write, 180–200 words in the body of the letter.

Model answer

Mr John Fraser
Orthopaedic Surgeon
Department of Orthopaedics, City General Hospital
6 October 2026
Re: Mrs Grace Adeyemi, aged 66
Dear Mr Fraser, I am writing to refer Mrs Grace Adeyemi, a 66-year-old woman with severe osteoarthritis of the left knee, whose symptoms have worsened despite a full course of physiotherapy. I would be grateful if you could assess her for further management, including surgical options. Her diagnosis was confirmed on X-ray, which showed severe medial joint space narrowing. Over the past 12 weeks, she completed a supervised exercise programme and received weight-management advice, losing 4 kg. Although her quadriceps strength has improved, her pain has increased from 5/10 to 7/10 and is now present at rest and at night. Her walking tolerance has fallen from 30 to 10 minutes, and she has had to give up her voluntary work because of pain. On examination, knee flexion is limited to 95 degrees, with a 5-degree fixed flexion deformity. Regular paracetamol and a topical anti-inflammatory have provided minimal benefit. Mrs Adeyemi is motivated and has engaged well with treatment. I would appreciate your opinion regarding the next stage of her care. Thank you for seeing her. Please do not hesitate to contact me if you need further information. Yours sincerely, Senior Physiotherapist Community Musculoskeletal Service

Body word count: 184 (target 180–200, excluding the address, date, salutation and sign-off).

Why this letter works

Purpose

Makes clear that conservative treatment has been tried in full — the key point for a surgeon deciding on next steps.

Content

Pain trend, night pain, reduced walking tolerance and range of movement give the surgeon objective evidence of failed conservative care.

Conciseness & Clarity

Session-by-session attendance and the family event are left out; “completed a supervised exercise programme” covers it.

Genre & Style

Surgeons in the UK and Australia are addressed as “Mr/Ms” — a small detail that shows awareness of the reader.

Language

Contrast is handled with accurate linking (“Although… has improved, her pain has increased”).

What was left out — and why

  • Attendance figures beyond noting the course was completed.
  • The family event, which doesn’t affect surgical decision-making.

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