Report features findings on COVID-19 effect on joint replacements

[THE 2021 Annual Report of the National Joint Registry (NJR) – its 18th – was presented at the Annual Congress of the British Orthopaedic Association, which took place from 21-24 September.

The report included a special feature on the effects of COVID-19 on joint surgery. And during the NJR’s presentation session at the congress, the authors of the feature addressed the impact of COVID-19 on last year’s surgical procedure volumes, alongside a moving presentation on the patient perspective of what it is like to be on a long waiting list, especially when combined with the on-going uncertainty of treatment timelines.

The study was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust, the University of Bristol, the NIHR Biomedical Research Centre at Oxford University Hospitals NHS Foundation Trust and the University of Oxford.

The research found that there was a ‘substantial deficit’ in joint replacement procedures carried out in 2020 compared to 2019. In all there were 106,922 (48.8%) fewer procedures performed in England, Wales and Northern Ireland – comprising 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.

The research also threw up discrepancies across the UK on the effect of the pandemic. Wales saw a reduction of 8,001 (67%) procedures and Northern Ireland a reduction of 2,833 (64%). That compared to 96,088 (47%) in England.

The report’s authors estimated that a 5% expansion in provision immediately compared to 2019 figures will make up the deficit over 10 years, while a 10% increase will make it up by 2026. However, those projections could be thrown into considerable doubt should fresh waves of the pandemic force further cuts.

The authors’ interpretation of the results reflects that: “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 to 2019 is urgently required to address this deficit.”

Summarising the report, the authors said: “The 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.”

Outlining the importance of joint replacement to the nation’s health and wellbeing, the report states: “Joint replacement is a common and important surgical procedure used to treat a variety of musculoskeletal problems including osteoarthritis and acute trauma. It is a highly successful procedure that reduces pain and disability enabling participation in and contribution to society. The Lancet described joint replacement as ‘the operation of the 20th century’.

“Joint replacements are long-lasting, with over half of hip and knee replacements lasting in excess of 25 years and 90% of shoulder replacements lasting in excess of 10 years. For very many people it is a curative procedure for the debilitating effects of end-stage arthritis.” q