Targeted rehabilitation to improve outcome after knee replacement (TRIO)
Professor Hamish Simpson
Type of grant
University of Edinburgh
Grant reference number
Joint replacement, Osteoarthritis, Knee pain
What are the aims of this research?
This clinical study will investigate the effect of targeting specific physiotherapy at patients who are functioning poorly in the early post-operative period after knee replacement (identified at 6 weeks post-op) and determine whether this early treatment improves the pain, satisfaction and functional outcome at 1 year compared to a group receiving routine care. This study will also investigate whether it is possible to identify characteristics that are predictors of poor outcome before the operation has taken place.
Why is this research important?
Osteoarthritis of the knee is an extremely common and disabling condition. Often the only treatment that can alleviate the patient's pain is a knee replacement and over 75,000 knee replacements are performed in the UK each year. Recent reports have indicated that around 20% of patients are not satisfied with their knee replacement 1 year after the operation, and therefore there is a need to identify these patients and determine if anything can be done to improve their outcome. Intense early physiotherapy for patients who are performing poorly has the potential to address the poor outcome and thereby improve patient function and satisfaction, however currently patients do not routinely receive outpatient physiotherapy after knee replacement. This study will investigate whether intense physiotherapy targeted at patients who are performing poorly 6 weeks after their knee replacement operation improves their long term function and satisfaction. In addition, the cost effectiveness of this approach will be evaluated. Ultimately it would be better from the patient's point of view if it were possible to identify which patients were destined to a poor outcome with current treatment before they have received a knee replacement, and therefore this study will also look at whether it is possible to predict pre-operatively which patients will have a poor outcome, particularly in terms of chronic pain and functional disability.
How will the findings benefit patients?
If early physiotherapy is shown to be beneficial this has the potential to improve the pain, satisfaction and function in over 15,000 patients per year in the UK alone. In addition this study will examine whether certain patient characteristics such as the body's response to a painful stimulus or a patient's expectations of the procedure are predictive of poor outcome. Identifying such characteristics may suggest strategies to prevent poor outcome such as pre-op physiotherapy, adaptations to the surgical or anaesthetic technique or the inclusion or exclusion of certain medications used before, during and after the operation.