Joint instability
Meaning of joint instability: For the purposes of this Statement of Principles, joint instability: (a) means an acquired lack of stability of a joint due to damage to or abnormality of the stabilising structures of that joint, manifesting as recurrent subluxation, recurrent dislocation or recurrent sprain; and (b) includes joints with an internal joint prosthesis; and (c) excludes spondylolisthesis, and the loosening or migration of the fixation component of an internal joint prosthesis. (3) While joint instability attracts ICD-10-AM code M22.0, M22.1, M23.5, M24.2, M24.4, M25.3, M43.3, M43.4, M43.5, M53.2 or T84.0, in applying this Statement of Principles the meaning of joint instability is that given in subsection (2). (4) For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.
Reasonable Hypothesis (RH) — Statement of Principles No. 57 of 2019
At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting joint instability or death from joint instability with the circumstances of a person's relevant service:
- (1)having physical trauma to the affected joint at the time of the clinical onset of joint instability;
Note: Examples of activities and circumstances involving trauma to the affected joint include, but are not limited to, falls, collisions, lifting weights, push ups, pull ups, throwing objects, seizure and electrical injury.
- (2)having a dislocation or subluxation of the affected joint before the clinical onset of joint instability;
- (3)having a sprain of the affected joint before the clinical onset of joint instability;
- (4)having damage to a soft tissue structure as specified before the clinical onset of joint instability;
Note: soft tissue structure as specified is defined in the Schedule 1 - Dictionary.
- (5)having a fracture or bony abnormality involving the articulating surfaces of the affected joint before the clinical onset of joint instability;
Note: Examples of conditions which can cause a bony abnormality include, but are not limited to, osteonecrosis, dysbaric osteonecrosis and femoroacetabular impingement.
- (6)having a disease process as specified affecting the normal structural or functional relationship between the articulating surfaces of the affected joint at the time of the clinical onset of joint instability;
Note: disease process as specified is defined in the Schedule 1 - Dictionary.
- (7)being pregnant within the six weeks before the clinical onset of joint instability;
- (8)for temporomandibular joint instability only, undertaking an activity or undergoing a medical procedure that involves wide opening of the mouth at the time of the clinical onset of joint instability;
Note: Examples of activities which may involve wide mouth opening include, but are not limited to, yawning, laughing, vomiting, coughing, and chewing large pieces of food.
Note: Examples of medical procedures that involve wide mouth opening include, but are not limited to, dental procedures, direct laryngoscopy, and intravenous administration of medications which cause drug-induced yawning.
- (9)for total hip prosthesis joint instability only, having lumbar spondylosis, lumbar intervertebral disc prolapse, lumbar spondylolisthesis, lumbar spinal stenosis or lumbar spinal fusion at the time of the clinical onset of joint instability;
- (10)for total hip joint prosthesis joint instability only, being obese at the time of the clinical onset of joint instability;
Note: being obese is defined in the Schedule 1 - Dictionary.
- (11)for tibiofemoral joint instability only, being severely obese at the time of the clinical onset of joint instability;
Note: being severely obese is defined in the Schedule 1 - Dictionary.
- (12)for total knee joint prosthesis joint instability only, having morbid obesity at the time of the clinical onset of joint instability;
- (13)for elbow joint instability only, having more than three local glucocorticoid injections for epicondylitis before the clinical onset of joint instability;
- (14)having physical trauma to the affected joint at the time of the clinical worsening of joint instability;
Note: Examples of activities and circumstances involving trauma to the affected joint include, but are not limited to, falls, collisions, lifting weights, push ups, pull ups, throwing objects, seizure and electrical injury.
- (15)having damage to a soft tissue structure as specified before the clinical worsening of joint instability;
Note: soft tissue structure as specified is defined in the Schedule 1 - Dictionary.
- (16)having a fracture or bony abnormality involving the articulating surfaces of the affected joint before the clinical worsening of joint instability;
Note: Examples of conditions which can cause a bony abnormality include, but are not limited to, osteonecrosis, dysbaric osteonecrosis and femoroacetabular impingement.
- (17)having a disease process as specified affecting the normal structural or functional relationship between the articulating surfaces of the affected joint at the time of the clinical worsening of joint instability;
Note: disease process as specified is defined in the Schedule 1 - Dictionary.
- (18)being pregnant within the six weeks before the clinical worsening of joint instability;
- (19)for temporomandibular joint instability only, undertaking an activity or undergoing a medical procedure that involves wide opening of the mouth at the time of the clinical worsening of joint instability;
Note: Examples of activities which may involve wide mouth opening include, but are not limited to, yawning, laughing, vomiting, coughing, and chewing large pieces of food.
Note: Examples of medical procedures that involve wide mouth opening include, but are not limited to, dental procedures, direct laryngoscopy, and intravenous administration of medications which cause drug-induced yawning.
- (20)for total hip prosthesis joint instability only, having lumbar spondylosis, lumbar intervertebral disc prolapse, lumbar spondylolisthesis, lumbar spinal stenosis or lumbar spinal fusion at the time of the clinical worsening of joint instability;
- (21)for total hip joint prosthesis joint instability only, being obese at the time of the clinical worsening of joint instability;
Note: being obese is defined in the Schedule 1 - Dictionary.
- (22)for tibiofemoral joint instability only, being severely obese at the time of the clinical worsening of joint instability;
Note: being severely obese is defined in the Schedule 1 - Dictionary.
- (23)for total knee joint prosthesis joint instability only, having morbid obesity at the time of the clinical worsening of joint instability;
- (24)for elbow joint instability only, having more than three local glucocorticoid injections for epicondylitis before the clinical worsening of joint instability;
- (25)inability to obtain appropriate clinical management for joint instability;
Aggravation-only factors: the factors in subsections 9(14) to 9(25) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.
