Demand and capacity for hip and knee replacements in NHS Wales before the COVID-19 pandemic: implications for future planning

Abstract

Background/Aims Joint replacement services in Wales were particularly affected by the COVID-19 pandemic, but waiting times had been high for several years before this. This study aimed to explore the hip and knee replacement activity in NHS Wales between 2000 and 2019 to indicate whether an existing gap between capacity and demand exacerbated the impact of the pandemic on waiting times. Methods A retrospective review was performed using publicly available databases, including the Patient Episode Database Wales and Stats Wales. Data relating to the number of hip and knee replacement operations performed between 2000 and 2019 and average waiting times were extracted and analysed. Data on the number of patients who underwent a hip or knee replacement during the study period after waiting over 36 weeks from referral were obtained by request to the Patient Episode Database Wales. Data were analysed descriptively. Results The 36-week referral to treatment target was not achieved for any year during the study period. Activity increased each year from 2000 to 2009, but varied substantially year to year afterwards. Average waiting times were at their lowest in 2009, but rose substantially after this point. Conclusions There had been a long-term lack of capacity for hip and knee replacements in NHS Wales for 20 years before 2020, which may have exacerbated the impact of the COVID-19 pandemic on waiting times for these services. Implementing more nuanced waiting time targets, based on the clinical effectiveness of procedures, may be more appropriate than blanket waiting time guarantees.