People struggling with ongoing pain after knee replacement surgery might benefit from personalised follow-up. Researchers supported by the Bristol BRC and a Programme Grant from the National Institute for Health and Care Research (NIHR) conducted a five-year project to see if a more personalised follow-up approach could help patients.
Eight hospitals in the UK took part in a trial of the Support and Treatment After Replacement (STAR) care pathway. This pathway is intended for people experiencing chronic pain 12 weeks after knee replacement surgery. It is designed to give them personalised care by assessing the causes of their pain and then referring them to appropriate, existing NHS services.
Researchers found pain levels in patients on the STAR care pathway were better than patients who weren’t on it. They also found the intervention to be cost effective. On average, the NHS saved £724 over 12 months for each patient on the STAR care pathway, compared to patients receiving usual care. The difference in costs was mainly because people receiving usual care had more hospital admissions and took more unpaid leave from work.
A primary total knee replacement is a common surgical procedure – more than 100,000 operations of this type are done in the UK each year. Their aim is usually to reduce pain, improve function and reduce disability.
However, 1 in 5 people who have their knee replaced continue to suffer from pain. The reasons why people experience pain after a knee replacement can vary. Pain can develop because of inflammation and other physical factors or depression and other mental health issues.
The STAR care pathway is intended to give people the help they need early on. This is important because treating chronic pain is more difficult once it becomes well-established. STAR also provides telephone follow-up to patients for up to 12 months, with the option of referral for additional treatment if needed.
Patients completed a questionnaire about their pain levels eight weeks after surgery. If they continued to experience chronic pain, they were then asked to attend a one-hour clinic within three months of surgery.
Specially trained health care professionals assessed patients at the clinic. This involved taking a history, questionnaires, a clinical examination of the knee, x-rays and blood tests. Patients were referred for further treatment if they needed it. This could mean that they were assigned physiotherapy or referred to other specialists, depending on their circumstances.
Patients were then followed up for up to 12 months to see how they were getting on. The same person who assessed a patient at the start would call them up to six times over that period. This continuity helped create a caring atmosphere and gave people confidence in their recovery.
Researchers spoke with patients who had taken part in the project and created a short video illustrating their work. People who received the STAR care pathway said it was a welcome source of support. Many were unprepared for the severity of pain after knee replacement, and how long it takes to recover afterwards.
Watch video here:
Rachael Gooberman-Hill, lead researcher for the STAR programme, said:
“When we start any research trial of a new treatment, we are never sure if it will work or not. In fact, as researchers it’s best that we are completely unbiased about whether it will work or not. At the end of over 5 years of research we were so pleased that the STAR care pathway made a difference to people who had pain after knee replacement.
“When a person has a knee replacement to relieve pain and then finds that they have long-term pain afterwards, it is a really difficult situation for them to be in. As a whole team we were enormously glad that our research will make a difference to people. We’re now looking forward to more work in this area to put things into practice. We’re keen to learn more about how the STAR care pathway can impact positively on people with pain and the NHS.”
Vikki Wylde, Wendy Bertram, Emily Sanderson, Sian Noble, Nicholas Howells, Tim J Peters, Andrew D Beswick, Ashley W Blom, Andrew J Moore, Julie Bruce, David A Walsh, Christopher Eccleston, Shaun Harris, Kirsty Garfield, Simon White, Andrew Toms, Rachael Gooberman-Hill on behalf of the STAR trial group