Guidance
This guideline covers care before, during and after a planned knee, hip or shoulder replacement. It includes recommendations to ensure that people are given full information about their options for surgery, including anaesthesia. It offers advice for healthcare professionals on surgical procedures and ensuring safety during operations. It also offers guidance on providing support and rehabilitation before and after surgery.
The recommendations in this guideline were developed before the COVID-19 pandemic.
Last reviewed: 19 December 2024
We added links to relevant technology appraisal guidance in the section on implants for primary elective hip replacement. This is to provide easy access to relevant guidance at the right point in the guideline only and is not a change in practice.
Next review: This guideline will be reviewed if there is new evidence that is likely to change the recommendations.
Recommendations
This guideline includes recommendations on:
- information and shared decision making for people having joint replacements
- preoperative rehabilitation
- anaesthesia
- tranexamic acid to minimise blood loss
- preventing infections and avoiding implant selection errors
- procedures for knee, hip and shoulder replacement
- postoperative and long-term care
Who is it for?
- Healthcare professionals in primary, secondary and tertiary settings
- Non-NHS organisations commissioned to provide services for the NHS or local authorities
- People having knee, hip or shoulder replacement, their families and carers
Guideline development process
How we develop NICE guidelines
Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.