Joint replacement (primary): hip, knee and shoulder

Structure

a) Evidence of local arrangements to ensure that adults who have had hip, knee or shoulder replacement receive advice on postoperative rehabilitation before they are discharged from hospital.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example, from clinical protocols.

b) Evidence of the availability of members of the physiotherapy or occupational therapy teams to discuss postoperative rehabilitation with adults who had hip, knee or shoulder replacement and give advice.

Data source: Data can be collected from information recorded locally by provider organisations, for example, from staff rotas. The Getting It Right First Time (GIRFT) orthopaedic surgery follow-up report (2020) includes the proportion of trusts who offer elective orthopaedic surgery and report they have rehabilitation services for total knee replacement that are resourced and designed as 7-day services to ensure quality of care across the whole week.

Process

Proportion of adults who had hip, knee or shoulder replacement who receive advice on postoperative rehabilitation during a discussion with a member of the physiotherapy or occupational therapy team, before discharge from hospital.

Numerator – the number in the denominator who receive advice on postoperative rehabilitation during a discussion with a member of the physiotherapy or occupational therapy team, before discharge from hospital.

Denominator – the number of adults who have had hip, knee or shoulder replacement who are discharged from hospital.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records or discharge summaries.

Outcome

a) Average health gain and improvement rate associated with patient-reported outcome measures (PROMs) for hip and knee replacement.

Data source: NHS Digital's PROMs collect pre- and postoperative data from patients having elective inpatient hip or knee replacement funded by NHS England. Health gain is reported at national, commissioning and provider levels. Improvement rates are reported at national and provider levels.

b) The percentage of patients reporting the results of their hip or knee replacement as 'excellent' or 'very good' and that their problems are 'much better' or a 'little better' after their operation.

Data source: Success and satisfaction scores are collected postoperatively as part of NHS Digital's PROMs. Success and satisfaction scores are reported at national level.

c) Average health gain and improvement rate associated with PROMs for shoulder replacement.

Data source: Preoperative data is collected by hospital trusts for the National Joint Registry (NJR) using the Oxford Shoulder Score. The NJR collects the postoperative score. Overall changes between pre-and postoperative scores for primary elective shoulder replacement using rolling data collected by the registry are published in NJR annual reports.

Advice on postoperative rehabilitation

Postoperative rehabilitation needs are assessed through a discussion during the hospital stay. This is led by physiotherapy and occupational therapy teams but supported by the whole multidisciplinary team.

The type of rehabilitation offered should be based on the outcome of this discussion and reflect adults' clinical and personal circumstances, as follows:

The advice is given before discharge from hospital and should consider the needs of adults with cognitive impairment, for whom supervised group or individual outpatient rehabilitation should be considered.

Advice on self-directed rehabilitation includes:

For adults who have had hip replacement, the advice may include observing precautions recommended by the surgical team to prevent dislocation of the new, artificial joint. The advice will be dependent on daily activities, such as getting in or out of a car. [NICE's guideline on joint replacement (primary), recommendations 1.10.2 to 1.10.6 and adapted from the Royal College of Occupational Therapists' 2017 practice guideline on occupational therapy for adults undergoing total hip replacement (member-only access), recommendations 21 and 22]