Improving Identification and Management of Modifiable Risk Factors in Hip and Knee Osteoarthritis: A Quality Improvement Project in an NHS Orthopaedic Interface Service

BACKGROUND: Hip and knee osteoarthritis are highly prevalent conditions associated with pain, disability and increasing demand on orthopaedic services. Best practice guidance emphasises early identification and optimisation of modifiable risk factors to improve outcomes following joint replacement, yet these are often inconsistently addressed in routine musculoskeletal care. This quality improvement project aimed to improve the consistency with which clinicians identified and acted on key modifiable risk factors during orthopaedic interface consultations. METHODS: The project was conducted in an NHS Orthopaedic Interface Service using the Model for Improvement. A retrospective audit of 291 consultations demonstrated low rates of documented action despite a high prevalence of modifiable risk factors. Four domains were prioritised: excess body weight, smoking, diabetes optimisation and psychosocial factors. A bundle of low-burden interventions was introduced through sequential plan-do-study-act cycles. Prospective monthly sampling of 180 consultations over six months assessed change over time. RESULTS: Across 180 prospective consultations, documented action increased from 30% to 78% among consultations where at least one targeted modifiable factor was present. Improvement was clearest for weight-related advice and signposting. Smoking, diabetes and psychosocial findings were limited by small denominators or variable documentation and were interpreted descriptively. The largest increase was observed following introduction of embedded workflow supports, although attribution to any single component is limited by the sequential QI design. CONCLUSION: A simple quality improvement bundle was associated with improved documentation of action on modifiable risk factors during routine osteoarthritis consultations, particularly for weight-related advice and signposting. Embedded documentation prompts may support more reliable care processes, but further work is needed to assess sustainability, patient-level outcomes and transferability to other settings.