Priority 8 from the Hip and Knee Replacement for Osteoarthritis PSP

UNCERTAINTY: What is the most effective pre and post operative patient education support and advice for improving outcomes and satisfaction for people with OA following hip/knee replacement?  (JLA PSP Priority 8)
Overall ranking 8
JLA question ID 0020/8
Explanatory note Not available for this PSP

Reference to an up-to date, relevant and reliable systematic review which does not refer to uncertainty but could be extended: McDonald S, Hetrick SE, Green S. Pre-operative education for hip or knee replacement. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD003526. DOI: 10.1002/14651858.CD003526.pub2. 

Health Research Classification System category Musculoskeletal
Extra information provided by this PSP
Original uncertainty examples

Long term outcomes and fitness of people after replacements after measured years ~ How long do the replacements last in relation to pts age/activity levels? ~ What is the best physio regime following knee surgery? ~ What is optimal post-operative exercise management? ~ evidence-based rehab exercise after joint replacement ~ Currently we are looking at predictive outcomes following surgery and patients expectations, but how do we tailor the patients post operative rehabilitation to improve outcomes? Should greater emphasis be placed on post-operative strength training to improve outcomes? ~ Which exercise approaches give rise to optimal short term recovery (i.e. @ 6 weeks) functional, strengthening, ROM. ~ What is the best exercise regime (and intensity of exercises) after hip and knee replacements? Are closed-chain better than open chain exercises after hip and knee replacement? ~ Best post-op rehabilitation regimen ~ What is the recommended dose intensity for post op TKR physiotherapy- while in hospital and on discharge home? ~ How much exercise should post op patients expect to perform in order to get their new knee or hip replacement as functional as possible? ~ Length, frequency and type of rehabilitation required to give the best post operative outcomes. ~ Studies have looked at pain relief following TKR with no significant difference in outcomes, how can we further investigate the role of physical activity in improving short and long term outcomes? ~ Does daily physiotherapy for post-THR or TKR patients have an effect on patients AROM, GAIT, walking aid requirement, wellbeing & functional activities at 2/6/12/18 months post-op? ~ Does monitored exercise aid recovery? ~ Does post operative rehabilitation aid functional recovery long term? ~ Does post op attendance at physiotherapy improve long term outcomes? ~ Does more physiotherapy after hip and knee replacement improve outcomes? ~ Do 'top-up' exercises (e.g. a 6-12 week strengthening programme) 12 months post-surgery improve long term outcomes after hip and knee replacement? ~ What type of follow up physiotherapy is the most effective post joint replacement and frequent should it be? (OPD vs groups vs community) ~ The level of exercise and impact a replacement can take, i.e could the patient return to sports such as skiing, running, squash and with what outcome for the joint and surrounding bone ~ Can 'younger' patients return to sport and how does this effect the life of the replacement in a specific sport/activity? ~ More info required on the longterm outcomes after hip and knee surgery in terms of work, activities of daily living, back to recreational activities ~ What are the experiences of people wanting to return to work following hip or knee replacement surgery?) ~ How can we improve patient awareness? ~ How can we present risks/benefits better to patients to help them make an informed choice ~ What questions do I need to ask about the make of replacements in order to ensure their efficacy? ~ Does patient education regarding pain relief improve long term outcomes after knee surgery? ~ Does preoperative patient education alter expectations and improve satisfaction?) ~ Does preoperative patient education alter expectations and improve satisfaction? ~ Should patients have a basic knowledge of the joint replacement surgery prior to being allowed surgery? ~ How can we make sure that patients do not continue with the invalid lifestyle after successful (technically) replacements? ~ Maintaining optimal health post surgery, including weight maintenance and diet considerations ~ advice on lifestyle changes ~ Can you exercise too much following surgery? At what point might exercise cause a problem with the device? Is there an intolerable stress level for devices? (Some patients were made aware of certain movements to avoid e.g. crossing legs or bending at the hip beyond knee level, others were not and now wonder whether this negatively impacted success of surgery, is this advice inaccurate?)

Submitted by Uncertainty identified by 10 patient/carers, 32 clinicians and 1 from clinician discussion group
Outcomes to be measured Effectiveness of pre and post operative patient education support 
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