The Medicines and Healthcare products Regulatory Agency (MHRA) issued a field safety notice (FSN) in December 2022 about some devices in the NexGen family of knee implants. The FSN was issued following notification by the National Joint Registry (NJR) Implant Scrutiny Committee in 2021.

The NexGen Stemmed Option Tibial Component was removed from the market because of that notice, although only use in combination with LPS Flex or LPS Flex GSF femoral components demonstrated higher revision rates, and only patients receiving the combination of devices were recommended to be reviewed.

As is standard with joint replacement FSNs, the NJR supplied hospitals with a list of all the patients who had this combination implant and were still alive and had not already had a revision procedure. This represented 9,125 cases from 102 hospitals. This all happened within 48 hours of the FSN being issued. For context, 11,965 of these were implanted if patients who had died or been revised were included.

In terms of the clinical impact, the NJR had first been asked to investigate use of high flex NexGen knees by a surgeon in 2014. Although the data did not meet the outlier threshold at that time, NJR did inform the MHRA because there appeared to be a particular mechanism of failure with these devices, namely tibial loosening. The MHRA followed its standard process of discussing the concerns with the manufacturer and the matter was closed since the data did not demonstrate a case to answer. NJR reported this again in 2021, by which time the data was more robust and the signal was stronger.

At the time for an implant to be rated 10A, which is a measure of implant success, according to the National Institute for Health and Care Excellence (NICE), a failure rate of 10% at 10 years was used. This has recently been changed to a failure rate of 5% at 10 years.

The failure rate of this implant combination at 10 years is 7%, which is still under the 10% threshold advocated by NICE. It is important that these patients remain under clinical and radiological review.

NJR has made no assessment of the financial impact of the NexGen family of knee implants.

In the financial year 2023/24, there were 120,172 hip procedures performed at a total cost of £1,241,784,028.35, with an average unit cost of £10,333.39. There were 86,781 knee procedures performed at a total cost of £737,241,451.39, with an average unit cost of £8,495.42. There were an additional 13,811 complex cases for hip or knee procedures performed at a total cost of £220,792,075.13, with an average unit cost of £15,986.68. The total cost for 246,995 cataract procedures was £363,849,348.97, with an average unit cost of £1,473.10.

There are currently 49,509 patients waiting for a knee replacement. The mean average National Health Service waiting time for this procedure is 28.7 weeks.

The Government is working to reduce the number of patients awaiting treatment across the country. The Elective Reform Plan, launched as part of the Government’s Plan for Change, sets out how we will get back to the NHS constitutional standard that 92% of patients wait no longer than 18 weeks from Referral to Treatment by the end of this Parliament, and will also ensure that patients have the best possible experience of care.

We have set an ambition for 2025/26 that we reach 65% of patients waiting no longer than 18 weeks nationally, and for all trusts to deliver a minimum 5% improvement by March 2026.

The Elective Reform Plan has committed to providing quicker access for patients to common surgical procedures by opening 17 new and expanded surgical hubs by June 2025, so more operations can be carried out. Dedicated and protected surgical hubs are transforming the way the NHS provides elective care by focusing on high volume low complexity surgeries.

There are currently 113 elective surgical hubs that are operational across England as of February 2025. These surgical hubs help separate elective care facilities from urgent and emergency care, improving outcomes for patients and reducing pressures on hospitals.

In the NHS Lincolnshire Integrated Care Board, as of 25 August 2024, there were fewer than five patients waiting more than 12 months for knee replacement surgery, and six patients waiting more than 12 months for hip replacement surgery.

In the East Midlands, as of 25 August 2024, there were 479 patients waiting more than 12 months for knee replacement surgery, and 244 patients waiting more than 12 months for hip replacement surgery. The data captures patients waiting in the NHS Derby and Derbyshire Integrated Care Board, NHS Leicester, the Leicestershire and Rutland Integrated Care Board, the NHS Lincolnshire Integrated Care board, the NHS Northamptonshire Integrated Care Board, and the NHS Nottingham and Nottinghamshire Integrated Care Board.

Based on the latest data available from Hospital Episode Statistics, the median length of stay for finished consultant episodes where a knee replacement was the main procedure, was two days.

For the year 2022/23, based on the latest data available from Hospital Episode Statistics, there were 87,584 finished consultant episodes (FCEs) and 11 attended outpatient appointments, with a knee replacement as the main procedure. Of the FCEs, 969 were day cases, where the patient was discharged from hospital on the same day that they were admitted. Day cases and attended outpatient appointments, which did not require an overnight stay in hospital, represented 1.1% of knee replacement operations.

The information is not held in the format requested.

The following table shows the average stay in hospital for patients undergoing elective knee surgery in England in 2010 and 2022/23.

The information requested is not held centrally.

The number of people waiting for hip and knee replacements is not captured separately but is a sub-set of trauma and orthopaedic data.

The number of people in South East London CCG waiting 18 weeks or more or 52 weeks or more for trauma and orthopaedic treatments in each month from February 2020 to July 2021 has been presented in the table below.

Data is only available from April 2020 as this was the point that the South East London CCG was formed.

The number of people waiting for hip and knee replacements is not captured separately but is a sub-set of trauma and orthopaedic data.

The number of people in South East London CCG waiting 18 weeks or more or 52 weeks or more for trauma and orthopaedic treatments in each month from February 2020 to July 2021 has been presented in the table below.

Data is only available from April 2020 as this was the point that the South East London CCG was formed.

As announced in September, an additional £1 billion has been provided this year as part of the Elective Recovery Fund, which can be accessed by local trusts if they meet the eligibility criteria to tackle the backlog. A further £8 billion was announced to transform elective services and increase activity across the following three years. The Department has also committed to £5.9 billion of capital funding to further support National Health Service in reducing the backlog of people waiting for procedures, tests and scans, including £1.5 billion for increased bed capacity, equipment and new surgical hubs.

The NHS is improving the efficiency of joint replacement surgery, using lessons learned from the high-volume low acuity approach piloted in London and developed by the Getting It Right First Time programme to streamline processes and utilise surgical hubs. NHS England and NHS Improvement continue to work with Versus Arthritis and are evaluating patient support and developing regional and system strategies focused on those waiting for elective surgery and their health and wellbeing.

As announced in September, an additional £1 billion has been provided this year as part of the Elective Recovery Fund, which can be accessed by local trusts if they meet the eligibility criteria to tackle the backlog. A further £8 billion was announced to transform elective services and increase activity across the following three years. The Department has also committed to £5.9 billion of capital funding to further support National Health Service in reducing the backlog of people waiting for procedures, tests and scans, including £1.5 billion for increased bed capacity, equipment and new surgical hubs.

The NHS is improving the efficiency of joint replacement surgery, using lessons learned from the high-volume low acuity approach piloted in London and developed by the Getting It Right First Time programme to streamline processes and utilise surgical hubs. NHS England and NHS Improvement continue to work with Versus Arthritis and are evaluating patient support and developing regional and system strategies focused on those waiting for elective surgery and their health and wellbeing.

The Department has provided £2 billion to the National Health Service to tackle the backlog, in addition to £8 billion over the next three years to increase activity and transform elective services. Trusts are encouraged to find innovative ways to deliver elective services, including high volume, low complexity approaches including surgical hubs for hip and knee replacements. The Department is also providing a £700 million Targeted Investment Fund to enable cutting edge technologies and to increase operating theatre capacity, thereby improving productivity in hospitals.

The data is not held in the format requested.

The data is not held in the format requested.

The data is not held in the format requested.

The recent Spending Review provided £3 billion for 2021/22 to support the National Health Service in tackling the impact of COVID-19. This included £1 billion to tackle long waiting lists and address backlogs by facilitating up to one million extra checks, scans and additional operations such as knee and hip replacement surgery.

Information on average waiting times for knee surgery is not published in the format requested. Knee surgery is included in the category ‘trauma and orthopaedics’, for which the median waiting time in weeks for October 2020 was 14.3 weeks.

The information is not held in the format requested.