Priority 4 from the Hip and Knee Replacement for Osteoarthritis PSP

UNCERTAINTY: What (health service) pre-operative, intra-operative, and post-operative factors can be modified to influence outcome following hip and knee replacement?  (JLA PSP Priority 4)
Overall ranking 4
JLA question ID 0020/4
Explanatory note Not available for this PSP
Evidence None available
Health Research Classification System category Musculoskeletal
Extra information provided by this PSP
Original uncertainty examples Does obesity raise the likelihood of prosthetic loosening/ failure?)  ~  What is the effect of weight on recovery from an major joint replacement?)  ~  What if the spine is out of alignment due to congenital dislocation of the hip which wasn't detected when a child plus the discs are disintegrating in the neck and lumber region to be taken into consideration, plus c.o.p.d if an operation is suggested)  ~  patients with personality disorders or other mental health issues-how do they fare compared to general population after joint replacement  ~  What are the long term implications of having a partial knee replacement rather than a total knee replacement?  ~  Are outcomes better with a TKR rather than a UKR followed by a TKR? UKR is less invasive but do you have better/worse mobility with a UKR?)  ~  Can changes to intra-operative techniques (e.g. surgical technique) be altered to reduce the incidence of continuing pain following knee replacement)  ~  The cost-benefit of wound closure with absorbable sub-cuticular suture versus skin clips)  ~  TKR - is there evidence to suggest that the patellofemoral joint should routinely be resurfaced? 
Submitted by Uncertainty identified by 8 patient/carers, 30 clinicians, and 2 from patient/ carer discussion groups 
Outcomes to be measured  
PSP information
PSP unique ID 0020
PSP name Hip and Knee Replacement for Osteoarthritis
Total number of uncertainties identified by this PSP. 123  (To see more about the Top 10, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 27 March 2014