Arthroplasty Care Practitioners Association. Promoting quality care for arthroplasty patients. 2023. (accessed 4 April 2023)

Australian Orthopaedic Association National Joint Replacement Registry. Hip, knee & shoulder arthroplasty: 2022 annual report. 2022. (accessed 4 April 2023)

Benner P. From novice to expert: excellence and power in clinical nursing practice.Menlo Park (CA): Addison-Wesley; 1984

British Orthopaedic Association. Primary total hip replacement: a guide to good practice. 2012. (accessed 4 April 2023)

Canadian Institute for Health Information. Hip and knee replacements in Canada. CJRR annual report, 2020–2021. 2022. (accessed 4 April 2023)

Czoski Murray CJ, Kingsbury SR, Arden NK Towards UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): protocol for an evaluation of the requirements for arthroplasty follow-up, and the production of consensus-based recommendations. BMJ Open. 2019; 9:(6)

Department of Health. The regulation of the non-medical healthcare professions. 2006. (accessed 4 April 2023)

Fan JCH, Lo CKM, Kwok CKB, Fung KY. Nurse-led orthopaedic clinic in total joint replacement. Hong Kong Med J. 2014; 20:(6)511-518

General Medical Council. Good medical practice: delegation and referral. 2013. (accessed 4 April 2023)

Health and Care Professional Council. Your guide to our standards for continuing professional development. 2012. (accessed 4 April 2023)

Health Education England. Multi-professional framework for advanced clinical practice in England. 2017. (accessed 4 April 2023)

Health Education England. Workplace supervision for advanced clinical practice: an integrated multi-professional approach for practitioner development. 2020. (accessed 4 April 2023)

Health Education England. Advancing practice: signpost for continuing CPD. 2021. (accessed 4 April 2023)

Kennedy DM, Robarts S, Woodhouse L. Patients are satisfied with advanced practice physiotherapists in a role traditionally performed by orthopaedic surgeons. Physiother Can. 2010; 62:(4)298-305

Lovelock TM, Broughton NS. Follow-up after arthroplasty of the hip and knee. Bone Joint J. 2018; 100-B:(1)6-10

Mohler SA, Mears SC, Kathiresan AR, Barnes CL, Stambough JB. Electronic medical record audit time logs as a measure of preoperative before total joint arthroplasty. J Arthroplasty. 2021; 36:(7)2250-2253

Mortimore G, Reynolds J, Forman D, Brannigan C, Mitchell K. From expert to advanced clinical practitioner and beyond. Br J Nurs. 2021; 30:(11)656-659

Murphy MT, Radovanovic J. Patient satisfaction with physiotherapists is not inferior to surgeons in an arthroplasty review clinic: non-inferiority study of an expanded scope model of care. Aust Health Rev. 2021; 45:(1)104-109

National Institute for Clinical Excellence. Joint replacement (primary): hip, knee and shoulder. NICE guideline NG157. 2020. (accessed 4 April 2023)

National Institute for Health and Care Research. Good clinical practice. 2022. (accessed 4 April 2023)

National Joint Registry. 19th annual report 2022. 2022. (accessed 4 April 2023)

Nursing and Midwifery Council. The code. Professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018. (accessed 4 April 2023)

New Zealand Joint Registry. The New Zealand Joint Registry twenty-three year report January 1999 to December 2021. 2023. (accessed 4 April 2023)

The role and responsibilities of the advanced scrub practitioner.PCC: London; 2007

Royal College of Surgeons of England. The curriculum framework for the surgical care practitioner. 2014. (accessed 4 April 2023)

Scottish Arthroplasty Project. Scottish arthroplasty report 2020. 2020. (accessed 4 April 2023)

Swedish Arthroplasty Register. Annual report 2021. 2021. (accessed 4 April 2023)

Walton MJ, Walton JC, Bell M, Scammell BE. The effectiveness of physiotherapist-led arthroplasty follow-up clinics. Ann R Coll Surg Engl. 2008; 90:(2)117-119

Wood C. Leadership and management for nurses working at an advanced level. Br J Nurs. 2021; 30:(5)282-286

The role of the advanced clinical practitioner in arthroplasty care

20 April 2023
Volume 32 · Issue 8


Demand for joint arthroplasty surgery in the UK has increased significantly over the past 10 years. Advanced clinical practitioner (ACP) roles in arthroplasty care, typically fulfilled by expert nurses or physiotherapists, have been developed to alleviate service pressures and facilitate care for the growing number of patients undergoing arthroplasty surgery. There are numerous different models of ACP-led services both in the UK and internationally, driven by local service and population needs. ACPs in arthroplasty care will be involved throughout the patient journey, including pre-operative assessment, peri-operative care and long-term surveillance. ACPs in arthroplasty care will develop expertise across all four pillars of advanced clinical practice and have the potential to influence and contribute to the development of guidance and policy for the future of arthroplasty care delivery, ensuring best quality, evidence-based practice is achieved.

Changing demographics and an ageing population have influenced an increased demand for arthroplasty surgery globally in the past three decades. The National Joint Registry for England, Wales and Northern Ireland (National Joint Registry (NJR), 2022) has recorded an increase of total hip replacement procedures from 42 484 to 98 649 and knee replacement procedures from 41 584 to 106 572 between 2004 and 2019; shoulder replacement procedures have also increased from 2545 in 2012 (when they were first added to the registry) to 7660 in 2019. These trends are also reflected in Scotland, and the Scottish Arthroplasty Project (2020) report numbers of hip, knee and shoulder replacements increasing between 2001 and 2019 from 4219 to 7929, 3343 to 7720 and 234 to 543, respectively.

Similar patterns have also been recorded internationally (Swedish Arthroplasty Register, 2021; Australian Orthopaedic Association National Joint Replacement Registry, 2022; Canadian Institute for Health Information, 2022; New Zealand Joint Registry, 2023). These increasing numbers, coupled with pressures on services from changing government targets and relative funding and staff cuts, have meant that new models for providing care for these patient groups are essential to improve access to services and reduce waiting times. In 2020, due to the effects of the COVID-19 pandemic on elective surgical procedures, there was a sudden decline in arthroplasty procedures across all groups (NJR, 2022) this has since resulted in soaring waiting times for routine procedures and further emphasised the requirement for efficient models of care delivery.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content