MOBILE and the provision of total joint replacement.

Modern joint replacements have been available for 45 years, but we still do not have clear indications for these interventions, and we do not know how to optimize the outcome for patients who agree to have them done. The MOBILE programme has been investigating these issues in relation to primary total hip and knee joint replacements, using mixed methods research. There have been five main strands: (1) Epidemiological investigations to find out who is receiving total hip and knee replacements in the National Health Service (NHS). This has shown that there are extensive variations in different regions of the UK, with inequalities and probable inequities in the provision of these operations; (2) Epidemiological work to ascertain the population-based needs for the operations, showing under-provision of knee joint replacements, and a relative reluctance of both patients and GPs to consider knee surgery; (3) Quantitative and qualitative research into the views of patients, health care professionals and the public on the indications for, and prioritization of, total hip and knee joint replacements. This has shown lack of agreement within or between professional groups, as well as a mismatch between the views of patients and the public, and those of professionals; (4) Theoretical and experimental work on patient-related outcome measures, and the development of new instruments to assess both pain and function in people with osteoarthritis, based on the International Classification of Function, as well as a new integrated model of function; (5) Cohort studies of patients undergoing hip or knee joint replacements to find out what the determinants of good and bad outcomes are. These studies have emphasized the huge variation in disease severity at the time of surgery. The challenge now is to use and implement our findings for maximum patient benefit.