Impact of preoperative education on early outcomes following hip and knee arthroplasty: a 21,000-patient multicentre NHS analysis

Aims: Preoperative education is routinely integrated into enhanced recovery pathways for hip and knee arthroplasty, yet its independent effect on early outcomes remains uncertain. This study examined whether completion of structured preoperative education was associated with length of stay (LOS), early mobilization, and 30-day readmission, adjusting for patient risk factors including frailty. Methods: A retrospective study was performed using routinely collected data from adults undergoing elective primary hip or knee arthroplasty across 17 NHS and independent hospitals (2019 to 2024). Completion of preoperative education (Advancing Quality measure HK-07) was the primary exposure. LOS and 30-day readmission were primary outcomes; early mobilization within 24 hours (HK-05) was secondary. Multivariable regression models were adjusted for age, sex, procedure type, comorbidity category, and Hospital Frailty Risk Score, with restricted cubic splines for non-linear age effects and cluster-robust estimation for site variation. Results: Of 21,225 included patients, 93.4% completed preoperative education and 97.2% mobilized within 24 hours. Completion of education was associated with a modest reduction in LOS, with the greatest effect observed in younger patients and attenuation beyond 70 years of age. No significant associations were observed between education and 30-day readmission, whereas completion of education was associated with early mobilization. Increasing frailty and comorbidity were associated with longer LOS and higher readmission risk. Conclusion: Preoperative education is associated with a shorter hospital stay for younger and lower-risk patients but does not appear to influence 30-day readmission. Frailty and comorbidity remain dominant drivers of outcome variation. Education should be considered one component of perioperative care, and additional tailored support may be required for older and frailer individuals. Cite this article: Bone Jt Open 2026;7(4):566–573.