Balancing analgesia and function with patient preference and readiness

We thank O'Sullivan and Soysa for their correspondence regarding our editorial on motor-sparing anaesthesia in lower limb arthroplasty and for their constructive emphasis on the patient perspective and the practical conditions required for motor preservation to translate into meaningful functional recovery [1, 2]. We agree with their central point that preserved motor function is not, in itself, a core outcome [2]. Rather, it represents potential for early rehabilitation and recovery, which may or may not be realised depending on: analgesic adequacy; patient goals and preferences; their readiness and confidence to mobilise; and the availability of appropriate support [1-3]. Where pain remains inadequately controlled, or where early mobilisation is neither prioritised nor realistically achievable in a supported manner, a motor-sparing approach may confer little benefit and could compromise overall recovery through avoidable discomfort [1, 2]. In our original framework, the question ‘Is early mobilisation feasible?’ was intended to reflect patient-level feasibility, including preference, readiness and capacity to participate, rather than physiological capability alone [1]. We acknowledge the authors' observation that this patient-centred interpretation could have been made more explicit in the text and the figure [1, 2]. To address this, we propose a minor amendment to the wording of the first decision point in the schematic (Fig. 1), revised to read: ‘Is early mobilisation feasible? (including patient preference and readiness)’. This clarification makes explicit that mobilisation feasibility is not solely a physiological consideration but also reflects patient engagement and preparedness. We hope this refinement reinforces the broader premise of the editorial: that the value of motor-sparing strategies is inherently context-dependent and should be aligned with what matters to the individual patient, the procedural demands and the resources available to deliver recovery pathways that are effective and patient-centred.