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4-year PhD Studentship: Development of a care pathway for dislocation after total hip replacement

   Faculty of Health Sciences

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  Dr Vikki Wylde, Dr Andrew Moore, Dr M Whitehouse, Dr Setor Kunutsor  No more applications being accepted  Self-Funded PhD Students Only

About the Project

Hip replacement is a common operation (>100,000 annually in the NHS) performed to relieve pain and improve function, predominantly for osteoarthritis. Implant survivorship is excellent, with 80% of hip replacements lasting at least 20 years [1, 2] and 90% of patients report good pain relief and function [3]. However, approximately 2% of patients experience dislocation [4]. Dislocation is when the head of the prosthetic femoral component comes out of its socket in the pelvis. This causes severe acute pain and requires immediate ambulance transfer to A&E for treatment, typically involving relocation of the joint under sedation or general anaesthetic to put the hip back into socket.

The impact of dislocation is substantial. The dislocation event itself is extremely painful, traumatic and distressing for patients [5]. After dislocation, patients report worse functional outcomes [6]. Fear of movement and reduced self-efficacy are common, with patients stopping or restricting their activities and experiencing ongoing difficulties with activities of daily living, employment, and social activities [5]. This can lead to a long-lasting negative psychological impact, resulting in a sense of vulnerability, helplessness and loss of confidence. Despite this, often little or no support is available from NHS services [5].

Aims and Objectives

The aim of this project is to design a care pathway to address the needs of patients who experience dislocation after hip replacement. Specific objectives are to:

  1. Evaluate the existing evidence on support needs and care pathways for patients who experience major adverse events after hip replacement
  2. Understand current service provision and the context in which the intervention will be implemented and identify potential barriers and facilitators to implementation
  3. Explore the needs and preferences of patients who experience dislocation after hip replacement and the healthcare professionals who provide care for these patients


To design the care pathway, the following programme of research will be conducted:

Evidence synthesis

Update of our previous systematic review from 2016 which evaluated support needs and care pathways for patients who experienced major complications after joint replacement [7]. Electronic databases will be searched to identify relevant studies. Records will be screened, and data extracted from eligible articles.

Mapping current provision and context

An online survey of 50 NHS hospitals will examine current provision and the context in which the intervention will be implemented to identify potential barriers and facilitators to implementation and generate knowledge about how the intervention could be operationalized in practice.

Qualitative interviews with patients and healthcare professionals

Qualitative interviews will be conducted with 25 patients who have experienced dislocation and 25 healthcare professionals to determine needs, preferences, perception and capacities of patients and NHS staff providing care for these patients. Interviews will be audio-recorded, fully transcribed and anonymised. A coding framework will be developed to inductively code the barriers to better care and support for dislocation.

Development of the care pathway

In collaboration with patient representatives, and informed by relevant theoretical models, the findings will be used to design a new care pathway.


Hip replacement, dislocation, intervention development, systematic review, qualitative survey

How to apply for this project

This project will be based in Bristol Medical School - Translational Health Sciences in the Faculty of Health Sciences at the University of Bristol.

Please visit the Faculty of Health Sciences website for details of how to apply

Funding Notes

This project is open for University of Bristol PGR scholarship applications (closing date 25th February 2022)
The University of Bristol PGR scholarship pays tuition fees and a maintenance stipend (at the minimum UKRI rate) for the duration of a PhD (typically three years but can be up to four years).


1 National Joint Registry. 17th Annual Report.
2 Evans et al. How long does a hip replacement last? Lancet 2019;16(393):647-54.
3 Rolfson et al. PROMs in Swedish Hip Arthroplasty Register. JBJS Br 2011;93(7):867-75.
4 Kunutsor et al. Risk factors for dislocation after primary total hip replacement. Lancet Rheum 2019;1:E111-21.
5 Carpenter et al. Dislocation following total hip replacement. 2019 EFORT Congress.
6 Hermansen et al. PROMs after hip dislocation in primary total hip arthroplasty is virtually unknown. Acta Orthop 2018;89(6):595-6.
7 Kunutsor et al. Health Care Needs and Support for Patients Undergoing Treatment for Prosthetic Joint Infection. PLoS One 2017;12(1):e0169068.
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