Development of a care pathway for dislocation after total hip replacement

Background

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 an accessible and inclusive care pathway to address the needs of patients who experience dislocation after hip replacement. Specific objectives are to:

1. Understand current service provision and the context in which the intervention will be implemented

2. Explore the needs and preferences of patients who experience dislocation after hip replacement and the healthcare professionals who provide care for these patients

3. Identify the potential barriers and facilitators to implementation and how the intervention could be operationalized and sustained in practice

Methodology

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

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, the findings will be used to design a new care pathway following MRC guidance on complex intervention development [7]. A theory and evidence-based approach to intervention development will be applied, with a focus on future implementation to develop an intervention that could be used in the real world and have long-term sustainability if shown to be clinically and cost-effective [8].

Apply for this project

This project will be based in Bristol Medical School - Translational Health Sciences.

Please contact [Email Address Removed] for further details on how to apply.

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