I investigated the relationship between psychological health before total knee arthroplasty (TKA) and health service outcomes after TKA. I developed a psychologically informed physiotherapy intervention for patients before TKA, and pilot tested this intervention, evaluating patient outcomes, health service outcomes and implementation outcomes. I developed and tested a training intervention to upskill physiotherapists in key aspects of this psychologically informed physiotherapy intervention.

My clinical experience in a socially disadvantaged context was that patients with psychological symptoms recovered slowly and had longer hospital stays after TKA. This delayed patient flow through the hospital which impacted costs and patient care. However, little evidence explored these relationships, nor potential solutions. Understanding who is at risk for longer hospital stays, and interventions to minimise this risk, are important to empower clinicians to meet the needs of these patients, and for patients, carers and healthcare providers to have realistic expectations of recovery and hospital stays. There is greater urgency to understand this now as enhanced recovery pathways for TKA are implemented rapidly following COVID-19 disruptions to elective surgery, with pressure to provide a high volume of procedures in a short period of time.

Musculoskeletal research and practice has …