Evidence review for inpatient hip and knee postoperative rehabilitation: Joint replacement (primary): hip, knee and shoulder

Current practice would suggest that rehabilitation following hip and knee replacement begins as soon as possible after surgery. However, following surgery, patients may experience post-operative complications including nausea, hypotension, pain, delirium and confusion. The orthopaedic team aim to minimise these complications, to facilitate a good post-operative recovery and ultimately a safe hospital discharge.

Core post-operative rehabilitation interventions focus on exercises to improve joint range of motion and strength, gait re-education and functional retraining to maximise independence in transfer ability (bed to chair/getting on-off the toilet or out of the shower/bath), personal care (washing and dressing) and wider activities of daily living.

An assessment of post-discharge rehabilitation needs is undertaken during the individual’s hospital stay, led by physiotherapy and occupational therapy teams but supported by the whole multidisciplinary team. This may lead to referrals for ongoing support to community physiotherapy or occupational therapy services, or to social services, or to third sector organisations.

Whilst there is consistency in the UK that individuals who have undergone primary elective hip or knee replacement receive some form of post-operative inpatient rehabilitation, there is variability and uncertainty in its content, when this should begin, and the frequency and duration of provision. Furthermore all these interventions have a cost to the NHS.

This review seeks to discover the most clinical and cost-effective in-patient rehabilitation interventions for people who have undergone hip and knee replacement, and in particular when this rehabilitation should begin.