Arthroplasty Patients; Not-Forgotten During COVID-19

By J Manara, J Murray, S Eastaugh-Waring, A Porteous, J Webb and D Clark
Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK

Corresponding author e-mail: [email protected].uk

Published 20 May 2020

The COVID-19 pandemic has left many Orthopaedic patients awaiting elective Total Hip and Knee arthroplasty surgery frustrated about their postponed surgery. There is anxiety with the uncertainty associated with when elective services will restart, on top of their ongoing arthritis symptoms. In addition, many of these patients will fall within the ‘at risk group’ leading to difficulties in arranging surgery when services do restart, depending on future social distancing guidance.

We are using the hiatus in elective practice to engage with our patients on the waiting list for lower limb arthroplasty so they are still in contact with the trust and can undergo a period of ‘prehabilitation’ prior to their surgery to make use of the extra pre-operative time.

This has been done through myRecovery ( who have designed an App specifically designed for the Coronavirus pandemic ( myRecovery are a healthcare based company who focus on the peri-operative care patients receive through an app.

Our patients are being sent a letter with a link to download the myRecovery Joint School app. Joint School is a pathway on the myrecovery app, which is free and works on both Apple and Android smartphones and tablets. The app contains a range of videos, articles and checklists along with interactive exercise videos and tools that enables patient to track their progress. The app is complemented by a weekly Joint School class, with gentle workouts, tips and techniques. This is streamed live online each week and made available shortly afterwards for anyone to view on the myrecovery YouTube channel:

Several studies have looked at the effects of prehabilitation on patient outcomes. A recent systematic review suggested that outcomes were improved in Total Hip Arthroplasty1. Some studies have suggested patients undergoing TKR gain 90 degrees of flexion post operatively faster having undergone a pre-operative home-based exercise programme and have a reduced length of stay following surgery2,3. Those patients with preoperative targeted proprioceptive training were shown to have improved standing balance although not to have improved clinical outcomes4. Preoperative physiotherapy in THR seems to result in improved outcomes more reliably with improved walking distance and gait parameters in the short term5 and seem to have a lasting effect on muscle strength and functional capacity post operatively6.

We hope this engagement with our patients will help them feel better informed about their planned surgery and the period of prehabilitation will have a beneficial effect following their surgery when more elective services resume. We feel this model could easily be replicated by other trusts. The joint school app has specifically been recommended by the BOA in their recent guidance on ‘re-starting non-urgent trauma and orthopaedic care’7.

Below is a copy of the letter our patients have been sent and a QR code directing patients directly to register with the joint school app.

Letter.png QR code.png



  1. Vasta S, Papalia R, Torre G, Vorini F, Papalia G, Zampogna B, et al. The Influence of Preoperative Physical Activity on Postoperative Outcomes of Knee and Hip Arthroplasty Surgery in the Elderly: A Systematic Review. J Clin Med. 2020;9(4):E969.
  2. Matassi F, Duerinckx J, Vandenneucker H, Bellemans J. Range of motion after total knee arthroplasty: The effect of a preoperative home exercise program. Knee Surg Sports Traumatol Arthrosc. 2014;22(3):703-9.
  3. Huang S-W, Chen P-H, Chou Y-H. Effects of a preoperative simplified home rehabilitation education program on length of stay of total knee arthroplasty patients. Orthop Traumatol Surg Res. 2012;98(3):259-64.
  4. Gstoettner M, Raschner C, Dirnberger E, Leimser H, Krismer M. Preoperative proprioceptive training in patients with total knee arthroplasty. Knee. 2011;18(4):265-70.
  5. Wang AW, Gilbey HJ, Ackland TR. Perioperative Exercise Programs Improve Early Return of Ambulatory Function After Total Hip Arthroplasty: A Randomized, Controlled Trial. Am J Phys Med Rehabil. 2002;81(11):801-6.
  6. Skoffer B, Dalgas U, Mechlenburg I. Progressive resistance training before and after total hip and knee arthroplasty: A systematic review. Clin Rehabil. 2015;29(1):14-29.
  7. British Orthopaedic Association (2020). Re-starting non-urgent trauma and orthopaedic care: Full guidance. Available at: (Accessed May 2020).