Nine months of joint replacement surgery lost due to COVID-19, study reveals

Nearly nine months of joint replacement surgery has been lost - around 160,000 fewer operations - since the start of the COVID-19 pandemic, a new study led by the University of Bristol has found. The research suggests returning to pre-pandemic levels will not tackle the backlog, and even with rapid expansion, it will take many years, if not decades, to fix this joint replacement crisis.

The study, published in The Bone & Joint Journal today [1 August], looked in detail at the effect of the COVID-19 pandemic on the numbers of joint (hip, knee, shoulder, elbow, and ankle) replacement surgery carried out in England, Wales, and Northern Ireland.

The researchers analyzed National Joint Registry (NJR) data between January 2019 and December 2022 inclusive, which includes all NHS and privately funded hip, knee, shoulder, elbow, and ankle replacement operations.

The study compared the period including and after the pandemic (2020 to 2022 inclusive) to how many operations would have been performed had surgery continued at the same level as 2019.

The research team found by the end of 2022 almost three quarters of a year of planned operations - 71.6 per cent of 2019 activity and 158,994 joint replacements - had been lost. This gap continues to increase and therefore the recovery from this deficit does not appear to have started. Knee, shoulder, and ankle surgery have been affected more severely than hip and elbow surgery.

The NHS has been more impacted than the private sector. By 2022, NHS activity was still only 73.2 per cent of 2019 levels, whereas operations in the private sector had increased to 126.8 per cent of 2019 levels. The private sector is now the main provider of joint replacements (53 per cent in 2022) in England, Wales, and Northern Ireland.

Wales and Northern Ireland have been worse affected than England. Both countries recorded a backlog of more than a year's worth of operations between 2020-2022; 136 per cent of 2019 for Wales and 121.3 per cent for Northern Ireland, whereas the deficit in England was 66.7 per cent.

Patients awaiting different types of joint replacement surgery in England, Wales, and Northern Ireland have been affected disproportionately, and recovery to pre-pandemic levels will be challenging. This will inevitably lead to many patients enduring unnecessary pain, disability and wider decline in mental and physical wellbeing."

Jonathan French, Clinical Research Fellow in the Bristol Medical School: Translational Health Science (THS), and corresponding author

Michael Whitehouse, Professor of Trauma and Orthopaedics in the Bristol Medical School: THS, and senior clinical lead for the paper, explained: "If capacity was immediately expanded by five per cent on top of 2019 levels it would take until 2040 to address the backlog. An immediate ten per cent expansion, if possible, would still take until 2031 to catch up. This represents a severe challenge that is currently underestimated in planning and provision that requires prioritization to mitigate the impact of debilitating joint related conditions on patients."

Tim Wilton, Medical Director of the NJR, added: "The value of the volume data held by the NJR is that we can glean an accurate insight into the longer-term impact of COVID on the supply and demand and provision of surgical orthopedic services. There is a clear need to plan and adjust service volumes based on this insight and research, so that patient waiting list numbers start to reduce across the different joints. These data, being based against the volume of cases done in 2019, are likely to be an underestimate of the catching-up required as the volume of cases was growing every year before 2019 rather than being static."

Joint replacement surgery is a common and very effective surgical procedure used to treat a variety of musculoskeletal problems including osteoarthritis and acute trauma. Joint replacements are long-lasting, with over half of hip and knee replacements lasting over 25 years, and 90 per cent of shoulder replacements lasting over ten years.

The research team would like to thank the patients and staff of all the hospitals in England, Wales, and Northern Ireland who have contributed data to the NJR, along with the
Healthcare Quality Improvement Partnership, the NJR Research Committee, and staff at the NJR for facilitating the research.

The study was supported by the National Institute for Health and Care Research Bristol Biomedical Research Centre (NIHR Bristol BRC), Orthopaedic Research UK (ORUK) and the British Hip Society (BHS).