Addressing frailty in patients undergoing total hip and knee replacements

Researchers from Bristol, Cardiff and Exeter have demonstrated that it would be possible to use a randomised controlled trial to evaluate a prehabilitation programme for frail adults undergoing total hip or knee replacement. Patients taking part in the Joint PREP (Joint Prehabilitation with Exercise and Protein) study found the programme acceptable. The research team also demonstrated that evaluating it with a larger trial would be possible.

A randomised controlled trial is a study during which different treatments are tried out on a group of participants. A prehabilitation programme helps patients prepare for surgery. It can reduce their risk of developing complications and improve recovery.

All Joint PREP participants received care as usual – this consisted of meeting with a surgeon before and after surgery. In addition to that, some participants were invited to take part in a 12-week prehabilitation programme. The prehabilitation programme trialled during the study was made up of:

• A home-based exercise programme
• Daily protein supplement
• Support in the form of six telephone calls over the 12-week programme period

The NHS performs more than 200,000 total hip and knee replacements each year. Up to a quarter of the patients undergoing these procedures are frail. Frailty is associated with a higher risk of death, admission to intensive care, longer hospital stays and readmissions, amongst others. We know that exercise combined with protein supplementation can improve health in people with frailty.

Professor Vikki Wylde, senior author, said:

“Our study demonstrates that a randomised controlled trial is feasible to evaluate a prehabilitation programme for frail patients undergoing joint replacement. It also identified some adjustments that would be needed to optimise how a future trial is designed.

“For example, we found that the exercises given to patients were too challenging for some of them. This means a future trial would have to include easier exercise options and make sure the work is tailored to individuals’ abilities.

“Our findings also suggested that participants could potentially be more likely to keep taking their protein supplements if we provided them with additional suggestions on how to make them taste better.”