The increasing burden of revision arthroplasty for infection and fracture: perspectives of a tertiary referral centre

Abstract

Background: In public hospitals the number of complex urgent and semi-urgent revision joint replacements has increased over time, conversely the number of primary joint replacements has decreased. This study aimed to investigate the effect of this change on service delivery of elective surgery and training in one large metropolitan hospital. Methods: We retrospectively reviewed changes in staffing, workload and all hip and knee joint replacements performed at the Royal Adelaide Hospital over a 20-year period, between January 2003 to December 2023. Results: The number of primary total hip replacements (THR) and total knee replacements (TKR) performed on elective lists has decreased from 210/year to 140/year. The number of revisions THR and TKR increased from 76/year to 219/year (135 septic). The number of patients awaiting elective surgery has increased from 220 in 1999 (THR 18) to 597 in 2024 (THR 69). Conclusions: There is an urgent need of decisions by local policy makers to plan for the continual increase in THR and TKR as well as revision joint replacements. The significant change in pathology requires consideration of staffing, training and funding to account for the increased number of complex septic revisions.