Priority 9 from the Hip and Knee Replacement for Osteoarthritis PSP

UNCERTAINTY: What is an ideal postoperative follow up period and the best long term care model for people with OA that have had hip/knee replacement? (JLA PSP Priority 9)
Overall ranking	9
JLA question ID	0020/9
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	Long term care, post surgery ~ What long term postoperative care would be beneficial to me? ~ Long term care and monitoring of patients who have had hip and / or knee replacement. ~ Long term rehabilitation, for patients under 50 years old ~ What is the best way to look after my new hip joints long term, and post 3 months hip precautions ~ How can you get more after care (Physiotherapy) for a replacement hip or knee? ~ Post op care and follow up regarding the viability of the hip replacement. There seems to be a degree of uncertainty as to how often follow ups should be carried out. ~ In hospital, different nurses had different ideas and suggestions during recovery, This left me confused. Why is there not a consistent recovery plan? ~ Post operative treatment is not standardised, patients of different surgeons had different post-op care in the hospital I had my joint replaced in and of course it varies from hospital to hospital. A lot seems to depend on the surgeon's preferences but this makes objective monitoring of outcomes much harder. ~ I would also like a triage system to be researched for patients when they experience problems. I had a really strange flare up a few years ago - which my GP treated with painkillers. By the time I was able to see my orthopaedic consultant I had more or less recovered, which is good, but as I found out a few months later that I had the type of implant that has been known to cause a lot of problems in soft tissue, then I would have liked to have been followed up a lot sooner. ~ If there is no long-term follow up, how can I tell whether the pain/problems that I am experiencing are 'normal'? ~ I feel that there should be more long-term advice and follow-up after surgery. ~ Do you think that if a knee replacement was necessary the patient should be followed up eg yearly to monitor other joints eg hips. ~ Can patients safely self manage and monitor hip and/ or knee replacements without regular clinical follow-up appointments? ~ What is the optimum time for review of implants once they begin to deteriorate? early or later. ~ What is the optimal follow up period post discharge for THR and TKR after surgery, should it be over the first three months, or spread out up to one year); Do patients get enough monitoring and treatment as they decide on knee replacement issues? ~ Is long term follow-up of any value to the patient/commissioner? How can we provide safe post-op care for patients with comorbidities without an expansion in high dependency care? ~ Long term postoperative care. Would better patient information help the patient along the pathway? (I had no info but with more at an earlier stage I could have considered something other than pain meds when physio failed...) Could such info would alert patients to issues that might need attention post-operatively before they became too acute? (All I know is that my new hip could last for up to 15 years!)Also, the seating arrangements, I have heard stories of people who’ve, whose seating, especially in the toilet, hasn’t been sufficiently high, and this has actually prevented the thing seating in properly.’
Submitted by	Uncertainty identified by 20 patient/carers, 4 clinicians, 1 from patient discussion group and 1 from Healthtalk Online data
Outcomes to be measured	Long term care model

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