Document Type

Journal Article

Publication Title

Journal of Critical Nursing




School of Nursing and Midwifery




Zhou, H., Ngune, I., Roberts, P. A., & Della, P. R. (2023). Integrated clinical pathways for lower limb orthopaedic surgeries: An updated systematic review. Journal of Clinical Nursing, 32(11-12), 2433-2454.



The objective of the study was to comprehensively synthesise the components of integrated clinical pathways (ICPs) and post-operative outcomes of patients undergone total hip and knee arthroplasty (THA & TKA) and hip fracture surgeries.


Previous systematic reviews examined components and effectiveness of ICPs for lower limb joint replacement and hip fracture surgeries.

Design and Methods

An updated systematic review guided by the Whittemore and Knafl (2005) framework. Electronic databases, Ovid MEDLINE, EBSCOhost-CINAHL, the Cochrane Reviews and Trails, EMBASE and PubMed, were searched from 2007 to 31 January 2021. Due to the heterogeneity of the methods and data collection tools of included studies, pooling of the quantitative data was not possible. Therefore, the included studies were synthesised and presented narratively under subthemes of arthroplasty and hip fracture surgeries. The PRISMA checklist for systematic reviews was used.


Twenty-four studies met selection criteria with 11 examined ICPs for hip fracture and 13 for the THA and TKA. Twenty-one ICPs were reviewed, and 33 components were extracted. The most frequently included components for hip fracture subgroup were ‘discharge disposition arrangement’ and ‘dedicated personnel and resources’. ‘Exercise plan’ and ‘pain management’ were for the arthroplasty subgroup. A significant reduction in the length of stay and post-operative complications were associated with the ICPs. Results were mixed for the effectiveness of ICPs in reducing unplanned hospital admissions, mortality rates, post-operative complications and hospital costs.


The number of ICP components varied across studies. This review could not recommend a one size-fits-all ICP that could be adapted for use for patients undergoing hip fracture and joint replacement surgeries.

Relevance for clinical practice

This review identified research evidence-based components considered as essential for the inclusion in ICP’s for hip fracture and arthroplasty surgeries. Further research is suggested to determine the patient experience and healthcare providers’ acceptance of ICPs.



Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

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