The recovery from the COVID-19 induced joint replacement deficit in England, Wales and Northern Ireland has not yet begun: an analysis of the National Joint Registry

Jonathan French, Kevin C Deere, Derek J Pegg, Timothy Jones, Mike R Reed, Michael R Whitehouse, Adrian E Sayers

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

Abstract

Aims
The COVID-19 pandemic has had a dramatic impact on provision of joint replacement services in England, Wales, and Northern Ireland. This study aimed to quantify the backlog, analyse national trends, and predict time to recovery.

Methods
Analysis of the mandatory prospective national registry of all independent and publicly funded hip, knee, shoulder, elbow and ankle replacements in England, Wales and Northern Ireland between 2019 and 2022 inclusive, totalling 729,642 operations. The deficit was calculated per year compared to a continuation of 2019 volume. Total deficit of cases created 2020-2022 was expressed as a percentage of 2019 volume. Sub-analyses were performed based on procedure type, country, and unit sector.

Results
Between 2020-2022 there was a deficit of 158,994 joint replacements. This is equivalent to over two thirds of a year of normal operating activity (71.6%). There were 104,724 (-47.1%) fewer performed in 2020, 41,928 (-18.9%) fewer performed in 2021, and 12,342 (-5.6%) fewer performed in 2022 respectively than in 2019.

Independent sector procedures increased to make it the predominant provider of joint replacements (53% in 2022). NHS activity was 73.2% of 2019 levels, while independent activity increased to 126.8%. Wales (-136.3%) and Northern Ireland (-121.3%) recorded deficits of more than a year’s worth of procedures, substantially more than England (-66.7%). It would take until 2031 to eliminate this deficit with an immediate expansion of capacity over 2019 levels by 10%.

Conclusion
The joint replacement deficit following the COVID-19 pandemic is now equivalent to over two thirds of a year of normal operating activity, and continues to grow. Patients awaiting different types of joint replacement, in different countries, have been affected disproportionately. A rapid and significant expansion in services is required to address the deficit, but even this will take many years.
Original languageEnglish
JournalBone and Joint Journal
Publication statusAccepted/In press - 29 Apr 2024

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