{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T09:50:32Z","timestamp":1773913832804,"version":"3.50.1"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2023,11,29]],"date-time":"2023-11-29T00:00:00Z","timestamp":1701216000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health Research (NIHR) Applied Research Collaboration West","award":["NIHR ARC West"],"award-info":[{"award-number":["NIHR ARC West"]}]},{"name":"HDRUK Better Care Partnership","award":["6.12"],"award-info":[{"award-number":["6.12"]}]},{"name":"NIHR Biomedical Research Centre at University Hospitals Bristol"},{"name":"Weston NHS Foundation Trust and the University of Bristol"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Aims<\/jats:title>\n<jats:p>Elective hip and knee replacement operations were suspended in April 2020 due to the COVID-19 pandemic. The impact of this suspension and continued disruption to the delivery of joint replacement surgery is still emerging. We describe the impact of the pandemic on the provision of publicly funded elective hip and knee replacement surgery at one teaching hospital in England and on which patients had surgery.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We included all elective primary and revision hip and knee replacements performed at one hospital between January 2016 and June 2021. Using data for the years 2016\u20132019, we estimated the expected number of operations and beds occupied per month in January 2020 to June 2021 using time series linear models (adjusting for season and trend). We compared the predictions with the real data for January 2020 to June 2021 to assess the impact of the pandemic on the provision of elective hip and knee replacements. We compared the length of stay and characteristics (age, gender, number of comorbidities, index of multiple deprivation) of patients who had surgery before the pandemic with those who had surgery during the pandemic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We included 6,964 elective primary and revision hip and knee replacements between January 2016 and June 2021. Between January 2020 and June 2021 primary hip replacement volume was 59% of predicted, and 47% for primary knee replacements. Revision hip replacement volume was 77% of predicted, and 42% for revision knee replacement. Median length of stay was one day shorter for primary (4 vs 3 days) and revision (6 vs 5 days) operations during the pandemic compared with before. Patients operated on during the pandemic were younger and had slightly more comorbidities than those operated on before the pandemic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The restricted provision of elective hip and knee replacements during the COVID-19 pandemic changed the patient casemix, but did not introduce new inequalities in access to these operations. Patients were younger, had more comorbidities, and stayed in hospital for less time than those treated before the pandemic. Approximately half the number of operations were performed during the pandemic than would have been expected and the effect was greatest for revision knee replacements.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0294304","type":"journal-article","created":{"date-parts":[[2023,11,29]],"date-time":"2023-11-29T18:33:38Z","timestamp":1701282818000},"page":"e0294304","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["The impact of restricted provision of publicly funded elective hip and knee joints replacement during the COVID-19 pandemic in England"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8654-353X","authenticated-orcid":true,"given":"Chris M.","family":"Penfold","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley W.","family":"Blom","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Theresa","family":"Redaniel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Jones","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Eyles","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Keen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Elliott","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Judge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,11,29]]},"reference":[{"key":"pone.0294304.ref001","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/S0140-6736(17)32154-2","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990\u20132016: a systematic analysis for the Global Burden of Disease Study 2016","volume":"390","author":"T Vos","year":"2017","journal-title":"The Lancet"},{"key":"pone.0294304.ref002","author":"National Joint Registry for England, Wales, Northern Ireland and the Isle of Man.","year":"2021","journal-title":"NJR 18th Annual Report 2021."},{"key":"pone.0294304.ref003","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1016\/S0140-6736(18)31777-X","article-title":"Hip replacement.","volume":"392","author":"RJ Ferguson","year":"2018","journal-title":"The Lancet"},{"key":"pone.0294304.ref004","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1016\/S0140-6736(18)32344-4","article-title":"Knee replacement.","volume":"392","author":"AJ Price","year":"2018","journal-title":"Lancet"},{"key":"pone.0294304.ref005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/bmjopen-2011-000435","article-title":"What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? 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