Background

Hip and knee replacements are common operations for patients with osteoarthritis. It is a major operation with a long recovery period. One-third to one-half of people waiting for hip or knee replacements are frail (physical vulnerable e.g. lower strength and less mobile) and may experience more complications and longer hospital stay. Evidence suggests that an improved diet with extra protein and pre-operative exercise may lead to fewer post-operative complications and faster recovery. However, no studies have looked at pre-operative protein and exercise in frail individuals undergoing hip or knee replacement in the NHS. ‌

Aim

We want to see if we can improve recovery from surgery in older people having hip or knee replacement by giving them protein and asking them to exercise daily in the weeks before their operation. First, we want to see if people are willing to do this by running a small study, called a ‘feasibility study’. If they are, we will design a larger study to test whether it improves recovery.

Research plan

We will recruit 60 frail patients who are over 65 years old and waiting for hip or knee replacement to take part. Participants will be randomly assigned to one of two groups. One group of people will follow usual care and will not be asked to make any changes to their diet or exercise. The other group of people will be asked to add protein (provided for them) to their diet each day and to follow a tailored home exercise programme for up to 12-weeks before their operation.

All participants will complete questionnaires about their health and quality of life, and information about post-operative recovery and time spent in hospital will be collected from medical records. We will invite some participants to be interviewed about their experiences of taking part.‌

The information we gather will tell us if we can run a larger study in the future.

Research team

The study is co-ordinated from the Musculoskeletal Research Unit, University of Bristol. The Chief Investigator is Dr Vikki Wylde, the Clinical Lead is Professor Michael Whitehouse and the Trial Manager is Dr Tanzeela Khalid. Team members include Professor Yoav Ben-Shlomo, Dr Marcus Jepson, Dr Clare England, Dr Emily Henderson, Wendy Bertram, Catherine Jameson, Dr Lucy Culliford, and Professor Shea Palmer.

The Joint PREP study is conducted in collaboration with the Musculoskeletal Research Unit’s patient involvement group, PEP-R.

Funding

This study is funded through a two-year grant from the National Institute for Health Research (Research for Patient Benefit grant, reference number NIHR202289).