Abstract

Background
The development of pre-operative interventions to improve clinical outcomes following total knee replacement surgery has been identified as a research priority. In the first step of a programme of research, we conducted a feasibility cohort study, which investigated the effect of modifiable lifestyle factors, including alcohol consumption, smoking, physical inactivity and living with overweight, on clinical outcomes following total knee replacement (PRO Knee). Alongside PRO Knee, we conducted an integrated qualitative study to understand the acceptability of the methods used in the PRO Knee study and to explore the experiences of patients waiting for total knee replacement surgery, along with their beliefs and experiences regarding lifestyle interventions.

Methods
Adult patients awaiting total knee replacement surgery, who had consented to participate in the PRO Knee study were eligible to participate. Semi structured interviews were conducted with all patients who provided informed consent for the qualitative study. Interviews were audio-recorded; transcribed in an intelligent verbatim format and data were analysed using the Framework Method.

Results
Ten participants (9 female, 1 male) were recruited (average age 70, range 56–88) and all interviews were conducted over the telephone. The recruitment and data collection processes of the PRO Knee study were acceptable to participants. Five further themes relating to the lived experience of waiting for and undergoing total knee replacement surgery were identified: 1) Osteoarthritis of the knee and co-morbidity; 2) The decision to have surgery; 3) Waiting for total knee replacement; 4) Lifestyle conversations and interventions; 5) Recovery from total knee replacement.

The burden of living with osteoarthritis of the knee was significant and participants had often experienced multiple unsuccessful interventions. Participants could recall lifestyle conversations, which they were open to, but were not offered support. Most participants were positive about participating in lifestyle interventions prior to surgery. The participants who had poor outcomes were left with intrusive pain, and feelings of regret.

Conclusion
The recruitment and data collection processes for the PRO-Knee feasibility cohort study were acceptable to participants and further study in this area is now warranted.