Improving Recovery After Knee Replacement Surgery: Reducing Complications and Avoidable Follow-Up Procedures

Summary

Total knee arthroplasty (TKA) is a high-priority elective orthopaedic procedure across the UK and Ireland. Despite generally favourable outcomes, a proportion of patients develop postoperative arthrofibrosis, resulting in pain, stiffness, reduced function and, in some cases, the need for manipulation under anaesthetic (MUA). These secondary procedures place additional demands on already pressured orthopaedic services and are associated with increased rehabilitation requirements and poorer long-term outcomes.

This PhD builds on innovative preliminary work undertaken within the Western Health and Social Care Trust, where an arthroplasty practitioner-led early intervention pathway identified patients at risk of postoperative stiffness and delivered intensive, predominantly virtual rehabilitation. Early findings suggest substantial potential to reduce avoidable MUA and improve service efficiency.

The project will undertake a multicentre, mixed-methods study across Northern Ireland, the Republic of Ireland and England to understand variation in outcomes, identify patients at greatest risk of postoperative stiffness, and develop an evidence-based intervention to prevent MUA following TKA.

The research will:

* Quantify the incidence of MUA and postoperative stiffness across participating centres.

* Identify demographic, perioperative and rehabilitation-related predictors of poor outcomes using routinely collected clinical data.

* Explore patients' experiences of stiffness, rehabilitation and MUA through qualitative interviews.

* Co-design and feasibility test an early, risk-stratified intervention aimed at preventing knee dysfunction and reducing the need for secondary procedures.

The project brings together a unique collaboration between Ulster University, Belfast and Western HSCTs, the Royal Orthopaedic Hospital and University of Birmingham, and University College Cork and University Hospital Waterford. By combining expertise from high-volume arthroplasty centres across multiple healthcare systems, the research will enable regional and international benchmarking of care pathways, support data-driven service redesign, and generate evidence to improve elective orthopaedic care throughout Northern Ireland and beyond.

AccessNI clearance required

Please note, the successful candidate will be required to obtain AccessNI clearance prior to registration due to the nature of the project.

Essential criteria

Applicants should hold, or expect to obtain, a First or Upper Second Class Honours Degree in a subject relevant to the proposed area of study.

We may also consider applications from those who hold equivalent qualifications, for example, a Lower Second Class Honours Degree plus a Master’s Degree with Distinction.

In exceptional circumstances, the University may consider a portfolio of evidence from applicants who have appropriate professional experience which is equivalent to the learning outcomes of an Honours degree in lieu of academic qualifications.

Desirable Criteria

If the University receives a large number of applicants for the project, the following desirable criteria may be applied to shortlist applicants for interview.

• Practice-based research experience and/or dissemination
• Experience or knowledge of research methods or other approaches relevant to the subject domain
• Work experience relevant to the proposed project
• Track record of peer reviewed publications
• Experience of presentation of research findings
• Relevant professional qualification

Equal Opportunities

The University is an equal opportunities employer and welcomes applicants from all sections of the community, particularly from those with disabilities.

Appointment will be made on merit.

Funding and eligibility

This project is funded by:

• Department for the Economy (DfE)
• Vice Chancellor's Research Scholarship (VCRS)

PhD Scholarships are available for this project and will cover:

• Tuition fees.
• A maintenance allowance of approximately £22,000 (exact rate is to be confirmed) per annum for three years, subject to satisfactory academic performance.
• A Research Training Support Grant (RTSG) of approximately £900 per annum.

To be eligible for these scholarships applicants must: be a UK or Irish national; or have pre-settled or settled status; or have indefinite leave to remain or enter.

Applicants should also meet the residency criteria which requires that they have lived in the EEA, Switzerland, the UK or Gibraltar for at least the three years preceding the start date of the research degree programme i.e. September 2027.

Applicants who already hold a doctoral degree or who have been registered on a programme of research leading to the award of a doctoral degree on a full-time basis for more than one year, or part-time equivalent, funded from any source, including self-financing students, are NOT eligible to apply for an award.

Students in full-time employment are not eligible for an award.

Due consideration should be given to financing your studies.

Part-time PhD scholarships may be available at a 0.5 pro rata rate of the full-time scholarship, which would require a six-year registration period.

The University will award a successful candidate one of the following scholarships for the project, depending on the funding available at the time an admissions offer is made:

1. Department for the Economy (DfE) PhD Scholarships
2. Vice Chancellor’s Research Scholarships (VCRS)

Please note that the Terms and Conditions for scholarships are subject to change for 2027/28.