Pre-operative education and prehabilitation provision for patients undergoing hip and knee replacement: a national survey of current NHS practice

Background:
Over 215,000 total hip replacements (THRs) and total knee replacements (TKRs) take place annually in the UK. Joint replacement has the longest waiting times of elective surgical treatments, with some patients waiting up to two years for surgery in the NHS. Pre-operative education and support interventions could improve both pre-operative health and optimise post-operative outcomes. However, current pre-operative NHS service provision is heterogenous and poorly described.

This study aimed to describe the current services and care provided to patients on NHS waiting lists for THR and TKR.

Methods:
A link to a national online survey about pre-operative education and prehabilitation was sent to relevant healthcare professionals involved in the pre-operative care of patients waiting for THR or TKR surgery at a sample of high-, mid- and low-volume NHS hospitals in the UK.

Participants were asked questions about what pre-operative education and pre-habilitation services were offered at their hospital, and any barriers or facilitators to delivering care. Frequency statistics were used to describe categorical data and free-text data were coded into categories.

Results:
Responses were received from 29 UK hospitals across seven regions. Pre-operative education was provided to patients at 28 hospitals, primarily at single session talks supplemented with booklets. Prehabilitation was provided to patients waiting for TKR at 17 hospitals and to patients waiting for THR at 14 hospitals. It comprised strengthening exercises and advice with written information. Three hospital respondents did not know if prehabilitation was provided before TKR and four hospitals before THR. Barriers to service provision include funding, staffing facilities, and lack of awareness/evidence on how best to deliver services.

Conclusions:
Prehabilitation services are not provided for all patients waiting for arthroplasty. Future work is needed to design and evaluate prehabilitation resources to optimise pre-operative health and improve patient outcomes after TKR and THR.