GIRFT webinar: Improving cMSK rehabilitation provision following lower limb joint replacement
Survey reveals national picture of community MSK rehabilitation services following joint surgery in a surgical hub
The results of a new national survey offer a comprehensive picture of community MSK rehabilitation services for patients who have hip and knee arthroplasty in a surgical hub.
The survey was developed collaboratively between NHS England’s Getting It Right First Time (GIRFT) programme, the British Orthopaedic Association (BOA), the Chartered Society of Physiotherapy (CSP) and Edge Health, and distributed to orthopaedic surgical hubs across England.
The findings – available on the GIRFT website here – highlight variation in referral processes, access to rehabilitation and the co-ordination of care between services. The authors also include a list of recommended enablers of good practice and actions which can be adopted by those commissioning and delivering post-operative rehabilitation services, to ensure patients receive timely and equitable access to rehabilitation, have an optimal recovery and improved patient experience.
-------------------------------------------------------
Find out more at webinar
GIRFT is hosting a webinar entitled ‘Improving cMSK rehabilitation provision following lower limb joint replacement – lessons from the GIRFT national review’.
The session will take place on Wednesday 3rd June, from 12.30pm to 1.30pm, and will present the findings of the survey plus best practice case studies from:
- The South West London Elective Orthopaedic Centre on the surgical aspect of the post-operative knee and hip rehabilitation pathway.
- South Tees Hospital NHS FT, who have trialled a return-to work occupational programme, OPAL (Occupational support for Patients undergoing Arthroplasty of the Lower limb).
- Northumbria Healthcare NHS FT on digital therapeutics in the lower limb arthroplasty pathway.
-------------------------------------------------------
Orthopaedic surgical hubs are a key component of the NHS elective recovery strategy, helping to increase productivity, reduce waiting times and improve access to high-volume procedures, including primary hip and knee replacement.
Access to high-quality rehabilitation following surgery is essential to support recovery, restore function and enable patients to return to their usual activities, so community musculoskeletal (MSK) services play a vital role in ensuring that patients gain the greatest possible benefit from their joint replacement.
The survey was carried out as part of GIRFT’s collaboration with the Government’s Joint Work and Health Directorate (JWHD) - the Musculoskeletal Community Delivery programme (MSK CDP) - which was established to help reduce the waiting list backlog for community MSK services and improve the quality of MSK care in the community to help people to remain economically active.
A key deliverable for the MSK CDP in 2025/26 was to evaluate access to community-based outpatient rehabilitation for post-operative patients following surgical hub attendance.
The survey received responses from 38 surgical hubs (45% response rate). The findings highlight considerable variation in how outpatient rehabilitation following hip and knee replacement is delivered. For example:
- Most surgical hubs report having direct referral pathways into community MSK services, but one in five describe challenges with referral processes, including uncertainty about pathways, reliance on GP-mediated referrals, and delays in onward care.
- Three in five respondents reported that patients are usually assessed within two weeks of referral, as recommended by the Community MSK Improvement Framework (NHS England, 2023) and the Standardising Community Health Services MSK core components description (NHS England, 2026), but this his varies significantly across regions.
- Two in five respondents noted differences in rehabilitation quality, particularly in the number of therapy sessions provided and delays in starting treatment.
- Support for return to work following arthroplasty was also variable – while two thirds of hubs reported that return-to-work discussions are standard practice, structured return-to-work programmes are rare, and fit note duration varies.
- A large proportion of respondents reported no access to digital rehabilitation support pre- or post-operatively, while those using digital tools offer a variety of platforms.