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New treatment reduces long-term pain after knee replacement surgery

Published: 28 January 2022

Research funded by the NIHR has shown that a new treatment pathway can reduce long-term pain for people who have had knee replacement surgery.

One hundred thousand knee replacement surgeries are carried out every year in the UK, usually to treat pain caused by osteoarthritis. However, around one in five patients find that they still have long-term pain after the operation.

The study, published in The Lancet Rheumatology, found that the STAR care pathway (Support and Treatment After joint Replacement) can reduce the severity of the pain and reduce the impact on patients’ everyday lives. The treatment could also save the NHS up to £14 million every year by reducing the number of patients who need to be admitted to hospital because of pain after their knee replacement surgery.

The researchers designed and tested the STAR care pathway in eight UK hospitals, randomly assigning patients to either follow the new care pathway or to have standard care after their knee replacement. The research, funded by NIHR Programme Grants for Applied Research, also looked at how likely patients are to have ongoing pain after their surgery, and investigated why they might not seek help.

Patients following the new care pathway were invited to an hour-long clinic three months after their surgery, where they filled out questionnaires, and had X-rays and blood tests to check for any infection. If necessary, they were referred for further treatment and they also had up to six follow-up phone calls over the next year to check how they were doing.

Rachael Gooberman-Hill, lead researcher for the STAR programme, Professor of Health and Anthropology and Director of Bristol's Elizabeth Blackwell Institute, said: “People have a knee replacement to relieve their pain and it’s immensely disappointing if they find that they have long-term pain afterwards. As a research team we wanted to do something that would help. We found that our new STAR care pathway had a positive impact on people’s pain.

“People who had long-term pain after their knee replacement and who were given STAR had less pain and the pain interfered less with their lives one year later. People told us that STAR helped them to feel supported, to find out more about their pain and STAR meant that they were able to get further treatment that was tailored to their pain.

“We are enormously pleased with our research findings because it should make a real difference to people who find that they have pain after their knee replacement.”

Brenig, a participant on the STAR trial, explained: “As part of the STAR trial, you have tailored physiotherapy appointments.  At my three-month review with a STAR physiotherapist, I was having a problem not being able to straighten my leg out.  She gave me some simple exercises, which worked and straightened the leg out. Occasionally I have problems at the back of the knee, then I do the exercises and it goes back to normal. So that was a very positive side of what we actually did.  

“I felt that being part of the STAR trial gave me access to a specialist physiotherapist. Her knowledge was far, far superior and specific to my issue. Some mornings I get up and feel on top of the world and then the following day I have leg pain. Eventually you get to accept it, but doing the exercises helps.”

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