An analysis of the effect of the COVID-19-induced joint replacement deficit in England, Wales, and Northern Ireland suggests recovery will be protracted.

Aims: The COVID-19 pandemic has disrupted the provision of arthroplasty services in England, Wales, and Northern Ireland. This study aimed to quantify the backlog, analyze national trends, and predict time to recovery. Methods: We performed an analysis of the mandatory prospective national registry of all independent and publicly funded hip, knee, shoulder, elbow, and ankle replacements in England, Wales, and Northern Ireland between January 2019 and December 2022 inclusive, totalling 729,642 operations. The deficit was calculated per year compared to a continuation of 2019 volume. Total deficit of cases between 2020 to 2022 was expressed as a percentage of 2019 volume. Sub-analyses were performed based on procedure type, country, and unit sector. Results: Between January 2020 and December 2022, there was a deficit of 158,994 joint replacements. This is equivalent to over two-thirds of a year of normal expected operating activity (71.6%). There were 104,724 (-47.1%) fewer performed in 2020, 41,928 (-18.9%) fewer performed in 2021, and 12,342 (-5.6%) fewer performed in 2022, respectively, than in 2019. Independent-sector procedures increased to make it the predominant arthroplasty provider (53% in 2022). NHS activity was 73.2% of 2019 levels, while independent activity increased to 126.8%. Wales (-136.3%) and Northern Ireland (-121.3%) recorded deficits of more than a year's worth of procedures, substantially more than England (-66.7%). It would take until 2031 to eliminate this deficit with an immediate expansion of capacity over 2019 levels by 10%. Conclusion: The arthroplasty deficit following the COVID-19 pandemic is now equivalent to over two-thirds of a year of normal operating activity, and continues to increase. Patients awaiting different types of arthroplasty, in each country, have been affected disproportionately. A rapid and significant expansion in services is required to address the deficit, and will still take many years to rectify.

Trochanteric fixation using a third-generation cable device--minimum follow-up of 3 years.

Third-generation trochanteric fixation cable systems are designed to overcome implant breakage, nonunion, and bony escape. The study prospectively assessed the functional and radiologic outcomes using such an implant. Forty-seven trochanteric fixations in 46 patients were performed over 4 years at 2 institutions using the Accord Cable Plate system (Smith and Nephew, Memphis, Tenn). Serial evaluation at a mean follow-up of 57 months demonstrated that the mean Harris hip scores improved from 52.3 preoperatively to 88.2 postoperatively (P < .001), and the mean pain score improved from 6.2 to 2.3, respectively (P < .001). No cable breakage, fretting, or fraying occurred. There were 2 cases of nonunion. A third-generation cable system appears to improve upon early-generation implants and provide favorable outcomes for reattachment of a trochanteric fragment in a variety of clinical scenarios.

Implementing large-scale data quality validation in a national arthroplasty registry to improve compliance : the National Joint Registry data quality audit programme.

Data of high quality are critical for the meaningful interpretation of registry information. The National Joint Registry (NJR) was established in 2002 as the result of an unexpectedly high failure rate of a cemented total hip arthroplasty. The NJR began data collection in 2003. In this study we report on the outcomes following the establishment of a formal data quality (DQ) audit process within the NJR, within which each patient episode entry is validated against the hospital unit's Patient Administration System and vice-versa. This process enables bidirectional validation of every NJR entry and retrospective correction of any errors in the dataset. In 2014/15 baseline average compliance was 92.6% and this increased year-on-year with repeated audit cycles to 96.0% in 2018/19, with 76.4% of units achieving > 95% compliance. Following the closure of the audit cycle, an overall compliance rate of 97.9% was achieved for the 2018/19 period. An automated system was initiated in 2018 to reduce administrative burden and to integrate the DQ process into standard workflows. Our processes and quality improvement results demonstrate that DQ may be implemented successfully at national level, while minimizing the burden on hospitals.Cite this article: Bone Jt Open 2022;3(9):716-725.