The feasibility of achieving Elective Care Framework targets for total hip arthroplasty and total knee arthroplasty in Northern Ireland
Alistair I. W. Mayne, MBChB, MSc, FRCS (Tr&Orth), Specialist Registrar, Trauma and Orthopaedic Surgery,corresponding author 1 Roslyn S. Cassidy, BSc(Hons), MMedSci, PhD, Data Analyst, 1 Paul Magill, MB MCh, FRCS (Tr&Orth), Consultant Orthopaedic Surgeon, 1 B. J. Mockford, MPhil, FRCS (Tr&Orth), Consultant Orthopaedic Surgeon, 1 Danny A. Acton, FRCS (Tr&Orth), Consultant Orthopaedic Surgeon, 1 and M. Gavan McAlinden, BSc MPhil FRCS (Tr&Orth), Consultant Orthopaedic Surgeon 1Hip
Aims
Waiting times for arthroplasty surgery in Northern Ireland are among the longest in the NHS, which have been further lengthened by the onset of the COVID-19 global pandemic in March 2020. The Department of Health in Northern Ireland has announced a new Elective Care Framework (ECF), with the framework proposing that by March 2026 no patient will wait more than 52 weeks for inpatient/day case treatment. We aimed to assess the feasibility of achieving this with reference to total hip arthroplasty (THA) and total knee arthroplasty (TKA).
Methods
Mathematical modelling was undertaken to calculate when the ECF targets will be achieved for THA and TKA, as well as the time when waiting lists for THA and TKA will be cleared. The number of patients currently on the waiting list and percentage operating capacity relative to pre-COVID-19 capacity was used to determine future projections.
Results
As of May 2021, there were 3,757 patients awaiting primary THA and 4,469 patients awaiting primary TKA in Northern Ireland. Prior to April 2020, there were a mean 2,346 (2,085 to 2,610) patients per annum boarded for primary THA, a mean 2,514 (2,494 to 2,514) patients per annum boarded for primary TKA, and there were a mean 1,554 primary THAs and 1,518 primary TKAs performed per annum. The ECF targets for THA will only be achieved in 2030 if operating capacity is 200% of pre COVID-19 pandemic capacity and in 2042 if capacity is 170%. For TKA, the targets will be met in 2034 if capacity is 200% of pre-COVID-19 pandemic capacity.
Conclusion
This modelling demonstrates that, in the absence of major funding and reorganization of elective orthopaedic care, the targets set out in the ECF will not be achieved with regard to THA and TKA. Waiting times for THA and TKA surgery in Northern Ireland are likely to remain greater than 52 weeks for most of this decade.
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