Around one in five people who have a hip or knee replacement still suffer long-term pain and disability after surgery. This project aims to change that by tackling the non-surgical factors that drive poor outcomes. The problem is that most research on joint replacements has focused on implant survival and surgical technique, not on what patients actually experience before, during, and after the operation. This programme addresses that gap by studying the full patient journey—from pre-surgery appointments to 12 months post-operation—and testing specific interventions that could improve results. If successful, the research could reshape how the NHS delivers joint replacement care. The team is developing new outcome measures for pain and disability, testing enhanced pain control in a trial of 600 patients, and designing a five-component care package that includes education, physiotherapy, occupational therapy, and management of other medical conditions. An economic evaluation will assess whether these changes are cost-effective for the health service. The final output will be consensus statements on best practice, giving hospitals clear guidance on what works.
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Aims To improve the experience and outcomes of people undergoing primary total hip or knee joint replacement (TJR) for osteoarthritis (OA).Specific objectives: 1) To update reviews of the relevant literature.2) To understand and assess the patient experience of and 'journey' through total joint replacement in current routine NHS care. 3) To complete the development and testing of new outcome measures of pain and disability. 4) To carry out a randomised controlled trial (RCT) of enhanced peri-operative pain control. 5) To assess the acceptability and feasibility of enhanced pre-operative pain control. 6) To design and pilot a 5-component package of peri-operative care. 7) To assess the economic implications of our strategy and trial results. 8) To develop consensus statements on best practice for TJR within the NHS. Background TJR is the end-stage surgical intervention for severe OA, aimed at relieving chronic joint pain. Over 100,000 TJRs are performed annually in the UK, making it one of the most common elective surgical procedures performed in the NHS. For many people TJR is a successful intervention, but approximately 20% of patients continue to experience significant long-term pain and disability post-operatively. Traditionally, research into TJR has focused on implant survivorship and surgical techniques and therefore relatively little research has been undertaken on improving patients experiences and outcomes. However, literature reviews by ourselves and others, accompanied by empirical data suggest that there are several determinants of poor outcomes after TJR that can be addressed with specific interventions, namely pain control, physiotherapy, patient education, occupational therapy and medical co-morbidities. Research PlansThe methods by which the research plans to fulfil the 8 research objectives are outlined below:1) Literature reviews will be conducted on determinants of outcomes after TJR, with a focus on peri-operative pain control. 2) Qualitative interviews will be conducted with approximately 40 patients, along with health care professionals, and their significant others. These interviews will explore the experience of TJR and provision of care, from pre-surgery appointment to 12-months post surgery. 3) We are currently developing new outcome measures of pain and disability, based on the theoretical framework of the International Classification of Function (ICF). These measures will be validated and compared with other standard measures in a cohort of 300 TJR patients who will be followed-up throughout the duration of the program.4) An RCT of peri-operative pain control will compare standard care with multi-modal analgesia in 600 TJR patients. 5) The acceptability and feasibility of the treatment options in the pain control RCT will be explored using qualitative interviews. 6) Pilot and feasibility work will lead to the development of a complex package of care designed to optimise patient outcomes after TJR, with patient choice as a central feature. The components will include: education, management of co-morbidities, occupational therapy and home assessments, physiotherapy and pain control. 7) An economic evaluation will assess the cost-effectiveness and implications of trial results.8) Consensus statements and research recommendations will be developed and disseminated to provide advice to health care providers on the best practice care for TJR patients. Research Team The Research Team includes academic Orthopaedic Surgeons and Rheumatologists, a research group (the 'MOBILE' programme) formerly funded by the MRC and now based at the University of Bristol, and specialists in health economics, clinical trials, pain control, physiotherapy, occupational therapy and rehabilitation, as well as Arthritis Care and Trust Management. Research EnviromentThe research will be based at the Avon Orthopaedic Centre, a large regional centre with a high through-put of TJRs. This environment is enhanced by the links wit
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