A new treatment program has proven effective in reducing people's ongoing pain and improving outcomes after their knee replacement surgery, according to a recently published study.

The aim of the five-year STAR (Support and Treatment After Joint Replacement) program was to find ways to improve the care and support that people with ongoing pain from their surgery receive. The program, funded by the National Institute for Health Research (NIHR), was recently tested in a randomised controlled trial across eight UK hospitals.

The study found patients who received the STAR care pathway had:

• Less pain severity and impact on daily life at both six and 12 months after treatment (nine and 15 months after surgery)
• Halved the number of hospital re-admissions
• Reduced length of hospital stay for any inpatient admissions three months after surgery
• Less unpaid time off work

The STAR care pathway consisted of three stages:

1. Three months after surgery patients attended an hour-long clinic, run by specially trained health care professionals
2. Detailed pain questionnaires were filled out and X-rays were taken as well as a blood test for infection. If needed patients were referred for further ongoing treatment
3. Patients received up to six phone calls over the next 12 months, making sure they had their referral, and checking how they were doing

In a statement released with the study, lead researcher Rachael Gooberman-Hill, Professor of Health and Anthropology and Director of Bristol's Elizabeth Blackwell Institute, said that "people have a knee replacement to relieve their pain and it's immensely disappointing if they find that they have long-term pain afterwards.”

“Unfortunately, one in five people who have knee replacement have long-term pain afterwards -- that is around 20,000 people each year in the UK alone."

"As a research team, we wanted to do something that would help. We found that our new STAR care pathway had a positive impact on people's pain. People who had long-term pain after their knee replacement and who were given STAR had less pain and the pain interfered less with their lives one year later.”

“People told us that STAR helped them to feel supported, to find out more about their pain and STAR meant that they were able to get a further treatment that was tailored to their pain.”

“We are enormously pleased with our research findings because it should make a real difference to people who find that they have pain after their knee replacement," she added.

Brenig, a participant on the STAR trial, said at the time that “as part of the STAR trial, you have tailored physiotherapy appointments.”

At my three-month review with a STAR physiotherapist, I was having a problem not being able to straighten my leg out. She gave me some simple exercises, which worked and straightened the leg out.”

“Occasionally I have problems at the back of the knee, then I do the exercises and it goes back to normal. So that was a very positive side of what we actually did."

"I felt that being part of the STAR trial gave me access to a specialist physiotherapist. Her knowledge was far, far superior and specific to my issue. Some mornings I get up and feel on top of the world and then the following day I have leg pain.”

“Eventually, you get to accept it, but doing the exercises helps," Brenig added.

Dr Vikki Wylde, Associate Professor in Musculoskeletal Health at Bristol Medical School (THS), and co-author added that "the new STAR care pathway provides benefit to people with pain at three months after knee replacement.”

“But we still need more research to understand how we could prevent people from developing this pain.”

“High-quality research to pre-operatively identify patients at high risk of developing pain after their operation is needed. These patients could be offered treatments to increase their chance of a good outcome after knee replacement."