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This summary covers the responsibilities of primary care providers for patients before they undergo a planned knee, hip or shoulder replacement. It includes recommendations to ensure that people are given full information about their options for surgery, and guidance on providing support and rehabilitation before and after surgery. The recommendations in this summary apply to primary healthcare settings only. See the full guideline for the complete set of recommendations.

Shared decision making and information

  • Follow the recommendations on communication, information and shared decision making in the NICE guideline on patient experience in adult NHS services when discussing treatment with people offered primary elective hip, knee or shoulder replacement
  • Support shared decision making by discussing treatment options with people offered primary elective hip, knee or shoulder replacement and their families or carers (as appropriate). Include in the discussions:
    • the alternatives to joint replacement
    • the potential benefits and risks of the available procedures and types of implant for joint replacement, including the possible need for more surgery in the future
    • the options for anaesthesia and analgesia, and the potential benefits and risks of each option (see the section on anaesthesia and analgesia in the full guideline)
  • Give people offered primary elective hip, knee or shoulder replacement and their family members or carers (as appropriate) information that is:
    • specific to the procedure they are being offered
    • in a format they can easily understand
    • provided starting at the first appointment, then whenever needed throughout their care
  • Give information on primary elective hip, knee or shoulder replacement that includes:
    • what to expect before, during and after surgery, including length of hospital stay, recovery and rehabilitation
    • who to contact if they have questions or concerns before or after surgery
    • preparing for surgery, including steps they can take to optimise their recovery (see the section on preoperative rehabilitation, below)
    • pain after surgery and how it can be managed
    • wound care
    • returning to work
    • returning to usual activities, for example playing sports, driving and sexual activity

Preoperative rehabilitation

  • Give people having hip or knee replacement advice on preoperative rehabilitation. Include advice on:
    • exercises to do before and after surgery that will aid recovery
    • lifestyle, including weight management, diet and smoking cessation (see NICE’s guidance on lifestyle and wellbeing)
    • maximising functional independence and quality of life before and after surgery
  • The committee were unable to make recommendations for practice regarding preoperative rehabilitation for shoulder replacement

Postoperative rehabilitation

  • Ensure that people who are undertaking self-directed rehabilitation have:
    • a clear understanding of their rehabilitation goals and the importance of doing the exercises prescribed to achieve these goals
    • a point of contact for advice and support
  • Offer supervised group or individual outpatient rehabilitation to people who:
    • have difficulties managing activities of daily living or
    • have ongoing functional impairment leading to specific rehabilitation needs or
    • find that self-directed rehabilitation is not meeting their rehabilitation goals
  • Consider supervised group or individual outpatient rehabilitation for people with cognitive impairment

Referral from primary care

  • Primary care practitioners should refer people who develop new or worsening pain, limp or loss of function related to their joint replacement to an orthopaedic surgical service

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Read the related Guidelines in Practice article

© NICE 2020. Joint replacement (primary): hip, knee and shoulder. Available from: nice.org.uk/guidance/ng157. All rights reserved. Subject to Notice of rights.

NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.

Published date: 04 June 2020.