joint replacement surgery guidelines

The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care. Founded in 1999, NICE was tasked with the remit of reducing ‘variation in the availability and quality of NHS treatments and care’. Since then, NICE has also taken on responsibility for ‘developing public health guidance to help prevent ill health and promote healthier lifestyles’, and the organisation has recently been asked to write a clinical guideline on primary hip, knee and shoulder joint replacements.

The necessity to craft guidelines such as this stem from the Getting It Right First Time (GIRFT) initiative, initially an orthopaedic initiative, which has been rolled out all across the UK in a number of specialities. GIRFT is responsible for improving the quality of medical care by ensuring as much consistency as possible in the way in which operations and aftercare are carried out.

Why were these guidelines required?

The key reasons why guidelines have been created in this area as follows:

  • Hip and knee joint replacement surgery is very prevalent, with tens of thousands of these operations being carried out in the UK every year
  • There is a great deal of variance in how these operations are done, with surgeons choosing different operative techniques and different materials, with huge variations in implant costs.
  • Aftercare programmes are similarly varied, with different advice given to patients from different practices. NICE’s aspirations from these guidelines are that “identifying the best approach for recovery and rehabilitation will enable all healthcare professionals to offer more effective and efficient treatment.”

The guidelines will assess nine key areas linked with hip and knee replacement surgery and will aim to make recommendations in as many of these areas as possible:

  • Assessment and shared decision-making
  • Preoperative rehabilitation
  • Anaesthesia
  • Tranexamic acid
  • Preventing infection
  • Wrong implant selection (left, right and incompatible components)
  • Joint replacement surgery
  • Postoperative rehabilitation
  • Long-term follow-up and monitoring

So, what does this mean for orthopaedic surgeons?

The answer really depends on the methods of practice that they favour at the moment. Some will need to adjust their methods while others will carry on as normal, within the boundaries of the new guidelines. Interestingly, these guidelines indicate that conventional ‘tried and trusted’ components put in with a conventional approach have great results and it is expected that this will form part of the recommendations moving forwards.

This is a market that has benefited from a lot of innovation and component testing over the years, and because of the vast number of these procedures that are carried out each year, there is a lot of available data to look at the relative strength and weaknesses of any new approach. It is important to remember that any new way of working – whether that is methodological, product driven or relating to aftercare – needs to be thoroughly tested and only the best will be recommended moving forwards.

NICE summarises, “it is important that all healthcare professionals, including surgeons and allied health professionals, and commissioners are involved in the entire care pathway (from community to hospital) to ensure people receive the best care, recovery, rehabilitation and follow-up monitoring after these common orthopaedic procedures.”

The guideline is due to be published in 2020 and we await its findings with interest.

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PA to Mr Bridle: Adriana Espinel-Prada
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