Priority 3 from the Revision Knee Replacement PSP

UNCERTAINTY: What are the most effective ways to organise health care and avoid delay to improve the results and patients’ experience of revision knee surgery? (JLA PSP Priority 3)
Overall ranking	3
JLA question ID	0093/3
Explanatory note	Studies in various fields have suggested that surgical volume may be related to patient outcomes, and following the success of centralisation of services within major trauma/ vascular surgery, health professionals were keen to explore the best models for infrastructure. Patient were also keen on organisation of services as it has a direct consequence on their experience and quality of life when dealing with a problematic knee replacement.
Evidence	None identified
Health Research Classification System category	Musculoskeletal

Extra information provided by this PSP
Original uncertainty examples	How can GPs improve how they respond to pain and stiffness after knee replacement? ~ Redo surgery involves careful op, constant care while hospitalized for wound, healing- this can make a big difference to how quickly the patient gets well and mobilised. A good surgeon who knows about infections, etc ~ Does a MDT approach to treating revision knee patients improve the outcome for patients? ~ Are periprosthetic fractures best managed as part as a trauma service or as part of an urgent elective service? ~ Is there a pathway that should be started when patients are still having problems at 1 year following knee replacement ~ Should patients be seen directly by the operating surgeon sooner rather than repeated primary care when having problems at 2 years
Submitted by	See data spreadsheet on JLA website

Extra information provided by this PSP

Original uncertainty examples

How can GPs improve how they respond to pain and stiffness after knee replacement? ~ Redo surgery involves careful op, constant care while hospitalized for wound, healing- this can make a big difference to how quickly the patient gets well and mobilised. A good surgeon who knows about infections, etc ~ Does a MDT approach to treating revision knee patients improve the outcome for patients? ~ Are periprosthetic fractures best managed as part as a trauma service or as part of an urgent elective service? ~ Is there a pathway that should be started when patients are still having problems at 1 year following knee replacement ~ Should patients be seen directly by the operating surgeon sooner rather than repeated primary care when having problems at 2 years

Submitted by

See data spreadsheet on JLA website

PSP information
PSP unique ID	0093
PSP name	Revision Knee Replacement
Total number of uncertainties identified by this PSP.	32 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	21 May 2019