Supporting older patients to make informed decisions about knee surgery

Researchers: Professor Alan Silman | Dr Abigail McNiven ...

Project overview


This project concerns older people aged 70 and over with severe knee osteoarthritis and other complex health needs who are being considered for joint replacement surgery. It will create guidance to help patients assess the risks and benefits of surgery and make the best decision for their own circumstances.

There is a growing demand for total knee replacement surgery, with patient numbers expected to increase in line with an ageing population. Although the majority of patients see a dramatic improvement in their quality of life after knee replacement surgery, a sizeable proportion have less benefit. One explanation for the latter might lie in previous research which shows around 80% of people over 75 have at least two chronic health conditions.  Patients with more than one physical or mental health condition have an increased risk of adverse effects following the operation, what is less clear is how these other disorders impact on the expected improvement in quality of life.

The project will involve a prospective study of older osteoarthritis patients who have been referred for possible knee replacement surgery and have other co-existing health problems. The researchers will use a longitudinal approach to examine decisions for surgery in the context of comorbid conditions. In-depth narrative interviews will be used to explore:

  • Patients’ experiences of living with severe knee osteoarthritis alongside other long-term health conditions
  • Patients’ decision-making journeys for total knee replacement
  • Patients’ feelings about their subsequent experiences
  • The impact of these treatment decisions on their wider health and lives

The recruitment process will cover a broad representation of patients across gender, age subgroups (within the over-70s), socioeconomic background, ethnicity, geographic variation, and the nature of their additional health issues. This ensures that future patients referring to the study’s findings will find experiences and perspectives representative of their own.

The findings will support patients and healthcare professionals to make informed decisions about joint surgery, appropriate for patients’ individual circumstances. Twenty-five accessible summaries for patients will be published on Healthtalk.org, illustrated with 250 video and audio clips from interviews with patients with severe osteoarthritis. The team will work with Age UK and Versus Arthritis to publicise these resources for patients. The research will also be disseminated to healthcare professionals through professional associations, annual conferences, social science and medical journals.

Team


  • Professor Alan Silman
    University of Oxford
  • Dr Abigail McNiven
    University of Oxford
  • Professor Sue Ziebland
    University of Oxford
  • Professor Andrew Price
    University of Oxford
  • Adam Barnett
    DIPEx Charity
  • Dr Sarah Drew
    London School of Economics and Political Science
  • Dr Carol Dumelow
    University of Oxford

  • Catherine Dennison headshot
    Programme Head, Welfare
    Nuffield Foundation
  • Director, Welfare
    Nuffield Foundation

Explore our projects

New

Welfare | 2024 - 2027

Gypsy, Roma, Traveller Youth: mitigating exclusions using the digital?

View project
A front view of a father and his two children. He is carrying his young son in his arms and his daughter is riding her scooter along the footpath as he pushes his son's scooter along the way.
New

Justice | Welfare | 2024 - 2026

Challenging justice inequalities with children in conflict with the law 

View project
New

Welfare | 2024 - 2027

Performance Tracker 

View project
Mother wearing hijab holding her toddler son on her knee, smiling at each other
New

Welfare | 2024 - 2025

Afghan resettlement in England: outcomes and experiences 

View project
A woman is sat on the edge of a bed staring at her phone while her daughter is in the background.
In progress

Welfare | 2023 - 2025

Virtual parent support portals: a new research and practice agenda

View project
A middle-aged man sat at home is looking at this phone while sorting pension paperwork.
New

Welfare | 2023 - 2025

Collective defined contribution pensions with investment choice

View project
three women walking along street laughing and smiling
New

Welfare | 2023 - 2025

Revealing social capital

View project
New

Welfare | 2023 - 2026

Universal Credit, good work and progression

View project
Three colleagues smiling and talking at work
New

Welfare | 2023 - 2026

Arthritis, work and wellbeing: a mixed methods study with policy recommendations

View project
A group of neighbours walking outside in a green space

Welfare | 2023 - 2026

Just neighbourhoods? Under-representation in UK community-led planning

View project
Elderly woman and adult daughter out shopping
In progress

Welfare | 2023 - 2026

Connecting pensions, health and care

View project
Teenager hugging their mother
In progress

Welfare | 2023 - 2026

The long-term effects of being a young carer

View project
A front view of a father and his two children. He is carrying his young son in his arms and his daughter is riding her scooter along the footpath as he pushes his son's scooter along the way.
New

Justice | Welfare | 2024 - 2026

Challenging justice inequalities with children in conflict with the law 

View project
New

Welfare | 2024 - 2027

Gypsy, Roma, Traveller Youth: mitigating exclusions using the digital?

View project
New

Welfare | 2024 - 2027

Performance Tracker 

View project
Mother wearing hijab holding her toddler son on her knee, smiling at each other
New

Welfare | 2024 - 2025

Afghan resettlement in England: outcomes and experiences 

View project
three women walking along street laughing and smiling
New

Welfare | 2023 - 2025

Revealing social capital

View project
A middle-aged man sat at home is looking at this phone while sorting pension paperwork.
New

Welfare | 2023 - 2025

Collective defined contribution pensions with investment choice

View project
New

Welfare | 2023 - 2026

Universal Credit, good work and progression

View project
A woman is sat on the edge of a bed staring at her phone while her daughter is in the background.
In progress

Welfare | 2023 - 2025

Virtual parent support portals: a new research and practice agenda

View project
A group of neighbours walking outside in a green space

Welfare | 2023 - 2026

Just neighbourhoods? Under-representation in UK community-led planning

View project
People looking at their mobile phones while waiting for job interview

Welfare | 2023 - 2024

Reliability and validity of crowdsourced workplace wellbeing data

View project
Teenager hugging their mother
In progress

Welfare | 2023 - 2026

The long-term effects of being a young carer

View project
Elderly woman and adult daughter out shopping
In progress

Welfare | 2023 - 2026

Connecting pensions, health and care

View project
A woman is sat on the edge of a bed staring at her phone while her daughter is in the background.
In progress

Welfare | 2023 - 2025

Virtual parent support portals: a new research and practice agenda

View project
Teenager hugging their mother
In progress

Welfare | 2023 - 2026

The long-term effects of being a young carer

View project
Elderly woman and adult daughter out shopping
In progress

Welfare | 2023 - 2026

Connecting pensions, health and care

View project
Mother, father, son and daughter standing in front of their house
In progress

Welfare | 2023 - 2025

A regional regeneration index to track socioeconomic ‘Levelling Up’

View project
Man working on a laptop using sign language on a video call
In progress

Welfare | 2023 - 2024

Designing inclusive remote and hybrid working to support disabled workers

View project
Children walking with their parents in the countryside
In progress

Welfare | 2022 - 2024

Children’s lives in changing places

View project
Older man working from home on a video call
In progress

Welfare | 2022 - 2023

The impact of pension auto-enrolment and COVID-19 on saving behaviours

View project
Worried woman alone in a room, resting her head on her arms
In progress

Welfare | 2022 - 2024

Links between cognitive impairment and exploitation in England

View project
A man working as a delivery driver sits in the driver's seat, checking his list on a tablet
In progress

Welfare | 2022 - 2023

Redesigning labour market policies for the future of work

View project
Older people drinking tea at a meeting at a community centre
In progress

Welfare | 2022 - 2024

Using administrative data to understand community well-being

View project
Two cheerful farmers standing outside a farm building looking at a tablet
In progress

Welfare | 2022 - 2024

Rural assets: policy and practice insights from the devolved nations

View project
A group of women walk in a park with their children in pushchairs
In progress

Welfare | 2022 - 2024

Nature-based integration: connecting communities with/in nature

View project
New

Welfare | 2024 - 2027

Gypsy, Roma, Traveller Youth: mitigating exclusions using the digital?

View project
New

Welfare | 2024 - 2027

Performance Tracker 

View project
Mother wearing hijab holding her toddler son on her knee, smiling at each other
New

Welfare | 2024 - 2025

Afghan resettlement in England: outcomes and experiences 

View project
three women walking along street laughing and smiling
New

Welfare | 2023 - 2025

Revealing social capital

View project
A middle-aged man sat at home is looking at this phone while sorting pension paperwork.
New

Welfare | 2023 - 2025

Collective defined contribution pensions with investment choice

View project
New

Welfare | 2023 - 2026

Universal Credit, good work and progression

View project
Three colleagues smiling and talking at work
New

Welfare | 2023 - 2026

Arthritis, work and wellbeing: a mixed methods study with policy recommendations

View project
A man driving a van at work
New

Welfare | 2023 - 2025

The PAW Trial: feasibility and acceptability of the Pain-at-Work Toolkit

View project
Two older women swimming in their local pool
New

Welfare | 2023 - 2025

The psychological, social and economic impact of musculoskeletal conditions

View project
Older woman using a tablet to make a video call
New

Welfare | 2023 - 2025

Remote osteoarthritis peer-mentorship for socioeconomically underserved people

View project
Teenager hugging their mother
New

Welfare | 2023 - 2025

Juvenile onset rheumatic diseases: education, vocational readiness, & employment

View project
Older woman at work using a laptop
New

Welfare | 2023 - 2026

Extending working lives for people with musculoskeletal conditions

View project
Grandparents having fun outdoors with their granddaughter, who is eating an apple and laughing: Understanding family and community vulnerabilities in transition to net zero
Reported

Welfare | 2021 - 2023

Understanding family and community vulnerabilities in transition to net zero

View project
Close up of a young girl and her father wearing protective face masks during the COVID-19 pandemic outside.
Reported

Welfare | 2021 - 2023

The Economy 2030 Inquiry: navigating a decade of change

View project
Toddler-gleefully-eats-baked-beans-How-COVID-19-is-affecting-food-security-proj
Reported

Welfare | 2020 - 2021

How the COVID-19 crisis is affecting food security

View project
Teenage-girl-looks-at-smartphone-next-to-laptop-Growing-up-under-COVID-19-PROJ
Reported

Education | Welfare | 2020 - 2022

Growing up under COVID-19

View project
Mother carrying daughter outside their home
Reported

Welfare | 2020 - 2022

COVID realities: families on low incomes during the pandemic

View project
Woman-looks-at-smartphone-screen-How-the-UK-public-gets-information-about-COVID-19-PROJ
Reported

Welfare | 2020 - 2020

How the UK public gets information about COVID-19

View project
Woman-medical-professional-treats-patient-impact-MSK-conditions-outcomes-other-illnesses-PROJ
Reported

Welfare | 2020 - 2022

The impact of musculoskeletal conditions on outcomes of other illnesses

View project
A middle-aged teacher sits at her desk and helps a female student with a problem in her textbook.
Reported

Education | Welfare | 2020 - 2020

Measuring the disadvantage attainment gap in 16-19 education

View project
Reported

Welfare | 2013 - 2017

IFS Green Budget 2013 – 2016

View project
Reported

Welfare | 2013 - 2016

Data about fathers in birth cohort studies (Life Study)

View project
Reported

Welfare | 2017 - 2017

General Election 2017

View project
Reported

Justice | Welfare | 2015 - 2018

Bridging the Evidence Gap in Family Proceedings

View project
Search projects

Profile