The COVID-19 induced joint replacement deficit in England, Wales and Northern Ireland

BackgroundThe COVID-19 pandemic has impacted health, economies and the functioning of societies globally. In addition to direct health effects, it has indirectly impacted population health by limiting access to non-COVID treatments, including joint replacements. The pandemic has necessitated re-organisation of healthcare with the private-sector providing support to public hospitals in some areas. The full impact is therefore difficult to ascertain from public data sources alone.MethodsWe used a mandatory prospective national register of private and publicly funded hip, knee, shoulder, elbow and ankle replacements in England, Wales and Northern Ireland. Descriptive analysis of the provision of joint replacement comparing data from 2019 to 2020 and predicted deficit recovery.FindingsThere was a substantial deficit in the provision of joint replacement in 2020 compared to 2019 with 106,922(48.8%) fewer procedures performed; resulting in 45,116 (44%) fewer hip replacements, 57,115(52%) fewer knee replacements, 3,878(50%) fewer shoulder replacements, 280 (33%) fewer elbow replacements and 533(53%) fewer ankle replacements performed. Wales and Northern Ireland were disproportionately affected with an overall reduction of 8,001(67%) and 2,833(64%) respectively compared to 96,088(47%) in England.An immediate 5% expansion in provision from the 2019 baseline will eliminate the deficit over approximately 10 years (by 2031), whilst a 10% expansion will address the deficit by 2026. InterpretationThis large national analysis of both private and publicly funded joint replacements illustrates a substantial accumulated deficit of surgery, equivalent to six-months of normal activity across England, Wales and Northern Ireland, due to the indirect effects of COVID-19. As the pandemic evolves, further waves of infection are likely to restrict surgery and see the deficit increase, therefore projections of time taken to address the deficit must thus be regarded as the best-case scenario. A significant expansion of joint replacement services compared 2019 is urgently required to address this deficit. FundingThis study was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston National Health Service Foundation Trust and the University of Bristol. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. This study was also supported by funding from the National Joint Registry. Posts of authors of this work are part funded by a grant from the National Joint Registry to conduct statistical analysis for the National Joint Registry. This study was supported by the NIHR Biomedical Research Centre at Oxford University Hospitals NHS Foundation Trust and the University of Oxford. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.