Catching up on joint replacements after COVID-19

The number of elective knee, hip and shoulder replacements dipped during the COVID-19 pandemic – what are the flow-on effects?

Before 2020, there had been significant growth in the number of joint replacements, and this was due to Australia’s population growth, an increasing average age of the population, high rates of obesity and an increase in sports-related injuries.

Prior to the COVID-19 pandemic (defined here as 2020–2022), the number of joint replacement procedures in Australia increased markedly between 2003 and 2019 and it’s expected to rise further.

During the pandemic, the number of elective joint replacement procedures in Australia substantially declined.

A new study, published in the Medical Journal of Australia, provides an updated estimate on the resulting shortfall in elective hip, knee and shoulder replacements in public and private hospitals across Australia.

Researchers wanted to determine the increase in the surgical case load needed to overcome the shortfall of procedures during the pandemic.

The study analysed data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) for elective procedures performed from 1 January 2012 to 31 December 2022.

Researchers included primary hip replacements (total conventional and resurfacing hip replacements; all diagnoses except neck of femur fracture), knee replacements (unicompartmental and total knee replacements; all diagnoses), and shoulder replacements (total resurfacing anatomic, stemless or stemmed anatomic, and stemmed reverse shoulder replacements; all diagnoses except fracture).

The study projects the annual number of elective joint replacements from pre-pandemic data (2012–2019) for people aged 65 or older. It also compared the annual numbers of elective hip, knee and shoulder replacements for public and private sector patients on a state, territory and nationwide basis between 2020 and 2022.

An estimated 42 307 fewer elective joint replacements were undertaken in Australia between 2020 and 2022 – far less than the projected annual numbers for 2012 to 2019.

The study also estimated the increase in surgical case load required to compensate procedure shortfalls for public sector patients by the end of 2024, 2025 and 2026.

The shortfall in elective joint replacement procedures (ie, the difference between actual and projected numbers) was 13 590 in 2020, 9555 in 2021 and 19 162 in 2022. The study found the shortfall was larger for public procedures, compared to private procedures (36 605 out of 42 307 or 86.5%).

To clear the backlog accumulated during the pandemic, the national annual case load would need to increase by 16% by the end of 2024, 10% by the end of 2025 or 8% by the end of 2026.

Victoria leads the states and territories with a 27% increase in case loads needed by 2024 to overcome the procedure deficits, followed by New South Wales at 16% by 2024 and Western Australia following at 18%.

The authors concluded that the number of elective joint replacement procedures performed in Australia has declined substantially since the onset of the COVID-19 pandemic, with public patients disproportionately affected.

The study calls for an urgent, national approach to reducing waiting times for public elective joint replacements.

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