Supporting older patients to make informed decisions about knee surgery

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.