Changes in hip and knee arthroplasty practice post-COVID-19 in the English NHS: a retrospective analysis of hospital episode statistics data.

Background: The COVID-19 pandemic significantly reduced hip and knee arthroplasty surgeries across the English NHS. With the resumption of regular operations postpandemic, efforts have been made to address the surgical backlog by maximising capacity. This study assesses the current activity rates of hip and knee arthroplasty in the NHS and their return to prepandemic levels.

Methods: We analysed hospital episode statistics from all English NHS providers of hip and knee arthroplasty from 1 April 2018 to 31 March 2023. Variables such as activity, location of surgery, length of stay and readmission rates were examined.

Results: Data for 706,772 hip and knee arthroplasty surgeries show that overall activity from 1 April 2022 to 31 March 2023 has decreased by 8.8% compared with the initial year of the study. During the last year, 38.4% of surgeries were performed in the independent sector, an increase from 29.6% in the first year.

Discussion: The postpandemic recovery phase has seen a strategic shift of surgeries to the independent sector, which helps reduce backlogs but poses risks to the role of the NHS in surgical training and innovation. This redistribution has immediate benefits for patient care but may impede trainee development and weaken research capabilities due to the lack of infrastructure in independent sectors. To maintain its leading role in orthopaedic care, the NHS needs to explore innovative solutions and strategic partnerships, incorporating advanced technologies and new training methods to adapt to the evolving healthcare landscape.