Recommendations for research

The guideline committee has made the following recommendations for research.

Key recommendations for research

1 Preoperative rehabilitation

What is the clinical and cost effectiveness of preoperative rehabilitation given at least 2 months before hip, knee or shoulder replacement?

For a short explanation of why the committee made the research recommendation on preoperative rehabilitation, see rationale and impact.

Full details of the research recommendation are in evidence review C: preoperative rehabilitation.

2 Information for people having a joint replacement

How should information for people having joint replacement surgery be delivered?

For a short explanation of why the committee made the research recommendation on information for people having a joint replacement, see rationale and impact.

Full details of the research recommendation are in evidence review A: information needs.

3 Early mobilisation of the shoulder

Is early mobilisation of the shoulder after primary elective shoulder replacement more effective than delayed mobilisation in restoring rapid return of function and relieving pain?

For a short explanation of why the committee made the research recommendation on early mobilisation of the shoulder see rationale and impact.

Full details of the research recommendation are in evidence review Q: inpatient shoulder postoperative rehabilitation.

4 Conventional compared with reverse total shoulder arthroplasty

What is the clinical and cost effectiveness of conventional compared with reverse total shoulder arthroplasty for adults having primary elective shoulder replacement for osteoarthritis with no rotator cuff tear?

For a short explanation of why the committee made the research recommendation on shoulder arthroplasty, see rationale and impact.

Full details of the research recommendation are in evidence review N: shoulder replacement – intact rotator cuff.

5 Analgesia for knee replacement

What is the clinical and cost effectiveness of adding a nerve block to regional or general anaesthesia, in combination with local infiltration analgesia, for primary elective knee replacements?

For a short explanation of why the committee made the research recommendation on analgesia for knee replacement, see rationale and impact.

Full details of the research recommendation are in evidence review E: anaesthesia for knee replacement.

6 Selective resurfacing in knee replacement

In adults having elective knee replacement, what is the clinical and cost effectiveness of total knee replacement with patella resurfacing compared with selective resurfacing?

For a short explanation of why the committee made the research recommendation on resurfacing in knee replacement see rationale and impact.

Full details of the research recommendation are in evidence review L: patella resurfacing.

Other recommendations for research

Decision aids

What are the components of a decision aid to support people referred for elective joint replacement in making decisions about their treatment (for example, the type of procedure, timing and implant choice)?

For a short explanation of why the committee made the research recommendation on decision aids, see rationale and impact.

Full details of the research recommendation are in evidence review B: decision aids.

Supplementary analgesia or anaesthesia in elective shoulder replacement

In adults having elective shoulder joint replacement with general anaesthesia, what is the clinical and cost effectiveness of supplementary local infiltration analgesia, a nerve block or regional anaesthesia?

For a short explanation of why the committee made the research recommendation on supplementary analgesia or anaesthesia in elective shoulder replacement, see rationale and impact.

Full details of the research recommendation are in evidence review F: anaesthesia for shoulder replacement.

Regional compared with general anaesthesia or a combination in elective shoulder replacement

In adults having elective shoulder joint replacement, what is the relative clinical and cost effectiveness of general anaesthesia, regional anaesthesia, and general combined with regional anaesthesia?

For a short explanation of why the committee made the research recommendation on regional compared with general anaesthesia, or a combination, in elective shoulder replacement, see rationale and impact.

Full details of the research recommendation are in evidence review F: anaesthesia for shoulder replacement.

Avoiding implant selection errors

What is the most effective technological solution for minimising wrong implant selection during joint replacement surgery?

For a short explanation of why the committee made the research recommendation on avoiding implant selection errors, see rationale and impact.

Full details of the research recommendation are in evidence review J: wrong implant selection.

Surgical approaches in primary elective hip replacement

Do the direct anterior, direct superior and supercapsular percutaneously assisted (SuperPATH) approaches to hip replacement improve patient-recorded outcome measures and reduce length of hospital stays, revision rates, neurological complications and surgical site infections compared with the posterior and anterolateral approaches?

For a short explanation of why the committee made the research recommendation on surgical approaches in primary elective hip replacement, see rationale and impact.

Full details of the research recommendation are in evidence review M: hip replacement approach.

Conventional total shoulder replacement compared with humeral hemiarthroplasty for people aged under 60

What is the clinical and cost effectiveness of humeral hemiarthroplasty compared with conventional total shoulder replacement for adults aged under 60 having primary elective shoulder replacement for osteoarthritis with no rotator cuff tear?

For a short explanation of why the committee made the research recommendation on conventional total shoulder replacement compared with humeral hemiarthroplasty for people aged under 60, see rationale and impact.

Full details of the research recommendation are in evidence review N: shoulder replacement – intact rotator cuff.

Procedures for shoulder replacement for people with a previous proximal humeral fracture

In adults having primary elective shoulder replacement for pain and functional loss after a previous proximal humeral fracture (not acute trauma), what is the clinical and cost effectiveness of reverse total shoulder replacement compared with humeral hemiarthroplasty?

For a short explanation of why the committee made the research recommendation on procedures for shoulder replacement for people with a previous proximal humeral fracture, see rationale and impact.

Full details of the research recommendation are in evidence review O: hemiarthroplasty – proximal humeral fracture.

Supporting rehabilitation after hip, knee or shoulder replacement for people with additional needs

What are the best ways to support rehabilitation after hip knee or shoulder replacement for people with additional needs (such as people with dementia, a learning difficulty or multiple disabling medical comorbidities)?

For a short explanation of why the committee made the research recommendation on supporting rehabilitation after hip, knee or shoulder replacement for people with additional needs, see rationale and impact.

Full details of the research recommendation are in evidence review R: outpatient hip and knee postoperative rehabilitation.

Outpatient rehabilitation after shoulder replacement

For people who have had primary elective shoulder replacement, does self-directed, supervised group or supervised individual rehabilitation produce the most improvement in health-related quality of life 2 years after surgery?

For a short explanation of why the committee made the research recommendation on postoperative rehabilitation after shoulder replacement, see rationale and impact.

Full details of the research recommendation are in evidence review S: outpatient rehabilitation after shoulder replacement.

Follow-up after shoulder replacement

What is the optimum time between follow‑up appointments for people who have had shoulder replacement, who should lead follow‑up and how this should be organised between hospital and community care?

For a short explanation of why the committee made the research recommendation on follow‑up after shoulder replacement, see rationale and impact.

Full details of the research recommendation are in evidence review T: long-term follow-up and monitoring.

  • National Institute for Health and Care Excellence (NICE)