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Background: The risk of re-operation, otherwise known as revision, following primary hip replacement depends in part on the prosthesis implant materials used. Current performance evidences are based on a broad categorisation grouping together different materials with potentially varying revision risks. We investigated the revision rate of primary total hip replacement (THR) reported in the National Joint Registry by specific types of bearing surfaces used., Methods and Findings: We analysed THR procedures across all orthopaedic units in England and Wales. All patients who received a primary THR between 2003 and 2019 in the public and private sectors were included. We investigated the all-cause and indication-specific risks of revision using flexible parametric survival analyses to estimate adjusted hazard ratios (HRs). We identified primary THRs with heads and monobloc cups or modular acetabular component THRs with head and shell/liner combinations. A total of 1,026,481 primary THRs were analysed (Monobloc: n = 378,979 and Modular: n = 647,502) with 20,869 (2%) of these primary THRs subsequently undergoing a revision episode (Monobloc: n = 7,381 and Modular: n = 13,488). For monobloc implants, compared to implants with a cobalt chrome head and highly crosslinked polyethylene (HCLPE) cup, the all-cause risk of revision for monobloc acetabular implant was higher for patients with cobalt chrome (hazard rate at 10 years after surgery: 1.28 95% confidence intervals [1.10, 1.48]) or stainless steel head (1.18 [1.02, 1.36]) and non-HCLPE cup. The risk of revision was lower for patients with a delta ceramic head and HCLPE cup implant, at any postoperative period (1.18 [1.02, 1.36]). For modular implants, compared to patients with a cobalt chrome head and HCLPE liner primary THR, the all-cause risk of revision for modular acetabular implant varied non-constantly. THRs with a delta ceramic (0.79 [0.73, 0.85]) or oxidised zirconium (0.65 [0.55, 0.77]) head and HCLPE liner had a lower risk of revision throughout the entire postoperative period. Similar results were found when investigating the indication-specific risks of revision for both the monobloc and modular acetabular implants. While this large, nonselective analysis is the first to adjust for numerous characteristics collected in the registry, residual confounding cannot be rule out., Conclusions: Prosthesis revision is influenced by the prosthesis materials used in the primary procedure with the lowest risk for implants with delta ceramic or oxidised zirconium head and an HCLPE liner/cup. Further work is required to determine the association of implant bearing materials with the risk of rehospitalisation, re-operation other than revision, mortality, and the cost-effectiveness of these materials., Competing Interests: MRW, AB, EM, AWB and EL are applicants on research grants funded by the NIHR to the University of Bristol. MRW, EM, AWB and EL hold a contract with the National Joint Registry (FTS 010307-2022: Statistical Analysis, Support and Associated Services). MRW conducts teaching on basic sciences for FRCS candidates, his employer receives market rate payments for his time for this teaching from Heraeus GMbH. The other authors have declared that no competing interests exist., (Copyright: © 2024 Whitehouse et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aims: The COVID-19 pandemic has disrupted the provision of arthroplasty services in England, Wales, and Northern Ireland. This study aimed to quantify the backlog, analyze national trends, and predict time to recovery., Methods: We performed an 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 January 2019 and December 2022 inclusive, totalling 729,642 operations. The deficit was calculated per year compared to a continuation of 2019 volume. Total deficit of cases between 2020 to 2022 was expressed as a percentage of 2019 volume. Sub-analyses were performed based on procedure type, country, and unit sector., Results: Between January 2020 and December 2022, there was a deficit of 158,994 joint replacements. This is equivalent to over two-thirds of a year of normal expected 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 arthroplasty provider (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 arthroplasty deficit following the COVID-19 pandemic is now equivalent to over two-thirds of a year of normal operating activity, and continues to increase. Patients awaiting different types of arthroplasty, in each country, have been affected disproportionately. A rapid and significant expansion in services is required to address the deficit, and will still take many years to rectify., Competing Interests: J. M. R. French reports a two-year clinical research fellowship funded by Orthopaedic Research UK and the British Hip Society, related to this study. K. Deere and A. Sayers report grants or contracts from Healthcare Quality Improvement Partnership: National Joint Registry, unrelated to this study. T. Jones reports a grant from the National Joint Registry, related to this study. D. J. Pegg is member of the National Joint Registry (NJR) executive committee and chairs the NJR data quality committee. M. R. Reed reports grants or contracts from Stryker, Zimmer Biomet, Heraeus, Link, Depuy, Smith & Nephew, Implantcast, Biocomposites, and Microsoft, consulting fees from Heraeus and Pharmacosmos, and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Zimmer Biomet, Heraeus, Stryker, Pharmacosmos, Ethicon, and Amotio, and stock or stock options in openpredictor Holdings and OPCI, and is an executive of the National Joint Registry, all of which are unrelated to this study. M. R. Whitehouse is the chief investigator for the lot 2 contract for the National Joint Registry: Statistical Support, Analysis and Associated Services, and reports royalties or licenses from Taylor & Francis, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Heraeus, and is a member of the editorial board of The Bone & Joint Journal and a member of the research committee for the British Orthopaedic Association and the British Hip Society., (© 2024 The British Editorial Society of Bone & Joint Surgery.)