Impact of pausing elective hip and knee replacement surgery during winter 2017 on subsequent service provision at a major NHS Trust: a descriptive observational study using interrupted time series

Timothy Jones*, Chris Penfold, Maria Theresa Redaniel, Emily Eyles, Tim Keen, Andrew Elliot, Ashley W Blom, Andrew Judge

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

1 Citation (Scopus)


Objectives: To explore the impact of a temporary cancellation of elective surgery in winter 2017 on trends in primary hip and knee replacement at a major NHS Trust, and whether lessons can be learnt about efficient surgery provision.

Design and Setting: Observational descriptive study using interrupted time series analysis of hospital records to explore trends in primary hip and knee replacement surgery at a major NHS Trust, as well as patient characteristics, 2016-2019.

Intervention: A temporary cancellation of elective services for two months in winter 2017.

Outcomes: NHS-funded hospital admissions for primary hip or knee replacement, length of stay and bed occupancy. Additionally, we explored the ratio of elective to emergency admissions at the Trust as a measure of elective capacity, and the ratio of public to private provision of NHS-funded hip and knee surgery.

Results: After winter 2017 there was a sustained reduction in the number of knee replacements, a decrease in the proportion of most deprived people having knee replacements, and an increase in average age for knee replacement and comorbidity for both types of surgery. The ratio of public to private provision dropped after winter 2017, and elective capacity generally has reduced over time. There was clear seasonality in provision of elective surgery, with less-complex patients admitted during winter.

Conclusions: Declining elective capacity and seasonality has a marked effect on the provision of joint replacement, despite efficiency improvements in hospital treatment. The Trust has outsourced less complex patients to independent providers, and/or treated them during winter when capacity is most limited. There is a need to explore whether these are strategies that could be used explicitly to maximise the use of limited elective capacity, provide benefit to patients, and value for money for taxpayers.
Original languageEnglish
Article numbere066398
Number of pages10
JournalBMJ Open
Issue number5
Publication statusPublished - 16 May 2023

Bibliographical note

Funding Information:
This research was funded by Health Data Research UK (HDR UK) Better Care South-West Partnership. EE, TJ and MTR's time was supported by the National Institute for Health Research Applied Research Collaboration West (NIHR ARC West). AJ and CP were supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or HDR UK.

Funding Information:
TJ, EE and MTR had financial support from NIHR ARC West for the submitted work. AJ has had financial support in the previous 3 years through institutional grants from NIHR, HDR UK, Versus Arthritis, Healthcare Quality Improvement Partnership (HQIP), Royal College of Physicians (RCP) and Health Foundation, had unpaid committee or leadership roles relating to musculoskeletal conditions for NIHR, Nuffield Foundation, Warwick CTU, and Versus Arthritis and a paid expert panel role for Nuffield Foundation Oliver Bird Fund; no other financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Publisher Copyright:
© 2023 Authors. All rights reserved.

Structured keywords

  • HEHP@Bristol
  • NIHR ARC West


  • Hip Replacement
  • Knee Replacement
  • Orthopaedic Surgery
  • Health Services Research


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