Development of a Cocreated Perioperative Joint Replacement Digital Care Pathway to Improve Surgical Outcomes Following Joint Replacement: Protocol for a Mixed Methods Study.

backgroundRecently, perioperative care has gained attention for its ability to improve outcomes, reduce costs, and enhance patient satisfaction, especially when multidisciplinary support is involved. Despite these benefits, patient compliance remains low due to limited engagement in program design and practical barriers such as transportation, particularly for older adults. Co-designed digital health solutions offer a promising, scalable approach to delivering personalized, accessible perioperative care, with emerging evidence supporting their feasibility and effectiveness in patients who undergo joint replacement.

objectiveThe objectives of this study protocol are to outline the methods to address three study aims: (1) understand gaps and unmet needs, including knowledge, perceptions, barriers, and acceptability, during the perioperative patient journey of hip and knee arthroplasty; (2) co-create a novel patient-centric digital care pathway (DCP) that provides education and systematically captures patient-reported outcomes; and (3) evaluate the feasibility of implementation, appropriateness, and acceptability of the pathway when tested in patients undergoing nontraumatic hip and knee joint arthroplasty.

methodsThis mixed methods co-design and implementation study will be conducted across 3 phases informed by the generative co-design framework for health care interventions. In phase 1 (predesign), patient interviews and journey mapping will be used to identify perioperative care gaps to be addressed in the DCP. In phase 2 (co-design), care gaps will be collaboratively framed, and iterative prototyping of the DCP will be conducted with consumer feedback and pilot testing. In phase 3 (evaluation), the feasibility of the DCP will be assessed using a previously reported framework. Inclusion criteria will vary across phases, focusing on people with lived experience or undergoing hip or knee joint replacement and relevant clinical or administrative staff.

resultsThe study was funded in September 2024, with phase 1 commencing in July 2025 and phase 2 in October 2025. Phase 3 is projected to commence before the end of 2025 and conclude 6 months later. As of October 2025, 13 people had been recruited, interviews were completed for phase 1, and recruitment for phase 2 had commenced.

conclusionsThis protocol enhances methodological transparency by detailing the co-design approach, strengthening the evidence base, and supporting the development of a credible, transferable DCP. It addresses the lack of patient-centric perioperative programs in joint replacement care by incorporating individual needs and preferences. The digital format helps overcome access barriers, such as transport limitations, enabling patients to engage with the pathway anywhere. Additionally, patient-reported outcome measures collected through the DCP will improve understanding of recovery trajectories following hip and knee replacements. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/85701.