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Derek Pegg is a Consultant Trauma and Orthopaedic Surgeon in Mid Cheshire Hospitals Foundation Trust, Leighton Hospital, Crewe. He is Chair of both NJR Regional Clinical Coordinators Committee and NJR Data Quality Committee.
Effects of COVID-19 pandemic on hip and knee joint replacement surgery in 2020 as demonstrated by data from the National Joint Registry (NJR) Derek Pegg, Adrian Sayers, Michael Whitehouse and Timothy Wilton On behalf of NJR (ahead of annual report September 2021)
We live history, in the present, while it is only future analysis that can provide a true portrayal of our times. Adrian Sayers is a Medical Statistician at Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol. He is the senior statistician for the NJR lot 2 contract for Statistical Analysis, Support and Associated Services.
T
he COVID-19 pandemic continues to exert a profound influence on the lives of individuals and societies around the world. As anticipated in the early phases of the response to the health crisis, it is having a significant effect on orthopaedic surgeons’ ability to provide joint replacement surgery (JRS) for patients. The National Joint Registry (NJR) provides independent and accurate data on this aspect of healthcare. Such data demonstrates that there has been over a 50% reduction in provision of JRS over the last twelve months. To alleviate this shortfall, if all hospital units were able to return to pre-pandemic levels along with an ambitious 10% increase in activity, we would see a minimum of five years before the ‘backlog’ is fully conquered. These estimates do not account for the ‘natural’ annual increase in the volume of service provision for joint replacements of approximately 5% that has been observed consistently to occur in the NJR data. Current trends suggest this backlog is continuing to increase and there is speculation that ‘catch up’ will take very much longer, even if considerable resources and investment can be provided. Last year was an unusual time for the provision of joint replacement surgery. By presenting analysis of registry data from 2020, we can clearly
38 | JTO | Volume 09 | Issue 02 | June 2021 | boa.ac.uk
demonstrate significant lowering of the volume of activity and get some insight into projected increases needed for recovery. At the time of writing (April 2021) volumes continue to be lower in comparison to pre-pandemic levels. Plans for recovery to previous levels of surgery are starting to be implemented in some hospital units but many other units continue to struggle, and some have barely re-commenced JRS. The ability to catch up with lost activity is a huge challenge everywhere, but we know, even as lockdown is lifted, that we may well face further issues in the months and years ahead, such as repeated waves of COVID-19. We hope this article will provide the nations’ health economy with objective insight into the effects COVID-19 has had on this type of elective surgery, assist in evaluating the magnitude of the challenge and help us return to pre-pandemic levels of JRS provision. It could also help calculate the time and potential resource required to regain the lost activity which will be crucial for complete recovery. We reviewed NJR data in total for years 2018 through to March 2021. We looked at hip and knee operations, performed in 2020. This was compared with 2019 activity, preceding the
