Patients left in limbo: NHS hip and knee surgery prep lacks consistency, national survey finds

Patients across the UK waiting for hip or knee replacement surgery may be missing out on vital pre-operative support, according to a new national survey of NHS hospitals led by Bristol BRC researchers. 

Every year, more than 215,000 total hip and knee replacements are carried out in the UK, yet many patients face long waits – sometimes stretching up to two years – for these life-changing procedures.  

The time before surgery is a crucial window to help patients physically and mentally prepare. This can be through education and targeted exercises, also known as prehabilitation or prehab. 

However, the new study reveals that what support patients receive depends heavily on where they live. 

Researchers surveyed 29 NHS hospitals from across seven UK regions. They found that while nearly all offered some form of pre-operative education – typically a single group session with an information booklet – only around half provided structured prehab programmes.  

These programmes, which include strengthening exercises and tailored advice, were offered more frequently to knee replacement patients (17 hospitals) than to those awaiting hip replacements (14 hospitals). Several hospitals reported uncertainty about whether such services were offered at all. 

Staff shortages, limited funding, and a lack of facilities were among the top barriers cited. Some respondents also highlighted a lack of clear evidence or guidance on best practices for delivering prehab. 

The study authors said: 

“This inconsistency in care is a missed opportunity. Better pre-operative support could improve health before surgery and lead to better recovery after.” 

The researchers are calling for national efforts to design and test effective prehab resources to ensure that all patients, regardless of postcode, are better prepared for surgery and recovery.