PRACTICE POINTER Primary care management of postoperative shoulder, hip, and knee arthroplasty

#### What you need to knowThe number of orthopaedic operations is increasing in the UK: the National Joint Registry reported just under 225 000 procedures in the period ending 2015-16.1 This practice pointer aims to inform the readership of the important considerations about arthroplasty of the knee, hip, and shoulder—the most common arthroplasty procedures performed in the UK.Arthroplasty in now routinely used to treat fractures and rotator cuff arthropathy. In 2015 in the UK over 83 000 primary total hip replacements took place, of which over 3700 were for neck of femur fractures, and over 4200 shoulder arthroplasties were performed for cuff arthropathy, representing around a quarter of all shoulder replacements.1 Enhanced recovery programmes have seen better standardisation of arthroplasty care and are now fully implemented in the NHS. They have been shown to reduce mortality, length of hospital stay, and transfusion requirements.2 They have four main steps, summarised in box 1.#### Box 1: Enhanced recovery programme steps:##### Step 1. Improve preoperative care##### Step 2. Reduce the physical stress of the operation##### Step 3. Decreasing postoperative discomfort