My Knee Plan

Over 110,000 total knee replacements (TKRs) are performed in the UK every year. One in five patients are dissatisfied with their outcome and/or have chronic pain after surgery. Some patients feel abandoned after their surgery and have expressed a need for more advice and support. About 5% of patients will have their operation cancelled at short notice, usually for avoidable medical reasons, which can have a negative effect on quality of life and relationships with healthcare professionals.

Continuity of care (care consistently delivered by a named contact) is important for patient satisfaction and has been shown to improve outcomes in several clinical specialties. Using this approach could help us improve patient outcomes and satisfaction. This is because we would be providing them with tailored treatment, support and education. However, it is an approach that has not been evaluated within orthopaedics.

Our co-production group

A group of 5 researchers, 5 healthcare professionals and 5 patients – the co-production group – was formed to collaborate on producing the care plan for patients having a total knee replacement. They met regularly throughout the project to review and discuss the data we collected. The results of these discussions informed the design of the care plan.

Please click here if you would like to:

• Find out more about our co-production group
• Read about their views on co-production

What we did

Reasons for cancellation

We collected information on the timing of, and reasons for, cancellation of total knee replacement surgery at 6 NHS hospitals in England, Scotland, Wales and Northern Ireland, over a period of 5 years between April 2018 and Mar 2023.

We found that, at the 6 hospitals over the 5 years, 17,223 total knee replacement operations were completed and 9,403 cancelled – more than previously thought. A quarter of the cancellations were less than 24 hours before surgery, and nearly one third were within 2 to14 days.

Lack of available hospital beds and patients being unfit for surgery were the most common reasons for short-notice cancellations. Many of these cancellations could have been avoided with advance planning.

Heart problems, infections and wounds were the main health reasons for cancelling surgery. With the right medical care while people wait for their operation, many patients could be supported to be medically fit for surgery, and cancellations avoided.

These findings highlight the need to provide better information and support for patients while they wait for knee replacement surgery, which is part of the aim of our wider project.

Care pathway for TKR patients – My Knee Plan

We developed My Knee Plan using a co-production approach that brought together patients, healthcare professionals and researchers to design a new care pathway for people having knee replacement surgery. After gathering evidence on why operations are cancelled, we also conducted interviews with 20 patients and 20 healthcare professionals to understand:

• Experiences of care
• Information needs
• Support during recovery
• Challenges patients face while waiting for surgery

We used the findings from these studies to create a long list of potential components for the intervention. After that we used a two-round Delphi survey involving 111 patients and 79 healthcare professionals to rate the importance of different elements of care.

Throughout the project, a co-production group comprising 5 patients, 5 healthcare professionals and 5 researchers met regularly to review the evidence, discuss the survey findings and make decisions about which components should be included in the final intervention.

The final intervention, My Knee Plan, provides personalised support from the point a patient is listed for surgery until three months after their operation. It includes health optimisation, education, tailored exercises, regular monitoring, reminders before surgery and access to a dedicated helpline.

Following completion of the knee replacement pathway, we worked with an expanded co-production group to adapt the intervention for people undergoing hip replacement surgery, creating the companion pathway, My Hip Plan.