Total elbow arthroplasty in England

Zaid Hamoodi, Adrian Sayers, Michael R. Whitehouse, Amar Rangan, Lianne Kearsley-Fleet, Jamie Sergeant, Adam C. Watts

Research output: Contribution to journalArticle (journal)peer-review

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Abstract

AimsThe aim of this study was to review the provision of total elbow arthroplasties (TEAs) in England, including the incidence, the characteristics of the patients and the service providers, the types of implant, and the outcomes.MethodsWe analyzed the primary TEAs recorded in the National Joint Registry (NJR) between April 2012 and December 2022, with mortality data from the Civil Registration of Deaths dataset. Linkage with Hospital Episode Statistics-Admitted Patient Care (HES-APC) data provided further information not collected by the NJR. The incidences were calculated using estimations of the populations from the Office for National Statistics. The annual number of TEAs performed by surgeons and hospitals was analyzed on a national and regional basis.ResultsA total of 3,891 primary TEAs were included. The annual incidence of TEA was between 0.72 and 0.82 per 100,000 persons before 2020 and declined to 0.4 due to a decrease in elective TEAs during the COVID-19 pandemic, with a slight recovery in 2022. Older patients, those of white ethnicity and females, were more likely to undergo TEA. Those who underwent elective TEA had a median wait of between 89 (IQR 41 to 221) and 122 days (IQR 74 to 189) in the years before 2021, and this increased to 183 days (IQR 66 to 350) in 2021. The number of TEAs performed by surgeons per annum remained unchanged, with a median of two (IQR 1 to 3). The median annual number of TEAs per region was three to six times higher than the median annual case load of the highest volume hospital in a region. Patients in the lowest socioeconomic group had a higher rate of serious adverse events and mortality (11%) when undergoing TEA for acute trauma.ConclusionIn England, TEA is more common in older age groups, those of white ethnicity, and females. The COVID-19 pandemic affected the incidence of elective TEA and waiting times, and the provision of TEA has not yet recovered. The Getting it Right First Time recommendation of centralizing services to one centre per region could result in up to a six-fold increase in the number of TEAs being performed in some centres.Cite this article: Bone Joint J 2024;106-B(11):1312–1320.
Original languageEnglish
Pages (from-to)1312-1320
Number of pages9
JournalBone and Joint Journal
Volume106-B
Issue number11
Early online date1 Nov 2024
DOIs
Publication statusPublished - 1 Nov 2024

Keywords

  • Total Elbow Arthroplasty (TEA)
  • National Joint Registry (NJR)
  • Hospital Episode Statistics (HES)
  • Elective surgery
  • acute trauma
  • COVID-19 impact
  • Incidence rate
  • Socioeconomic factors
  • Waiting times
  • Patient demographics
  • Serious Adverse Events (SAEs)
  • Implant types
  • Gender and age
  • inflammatory arthritis
  • Centralization of services

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