THE number of people paying to undergo hip and knee replacements privately in Scotland has nearly trebled compared to pre-pandemic levels. 

This “significant increase” has coincided with spiralling NHS waiting lists, and concern over a postcode lottery in orthopaedics recovery. 

It comes as several health boards sought to reassure patients that planned operations will go ahead on Monday, despite the bank holiday for the Queen’s funeral. 

The annual Scottish Arthroplasty Project (SAP) report, which audits all joint procedures, found that there were 2,755 first-time hip replacements carried out by independent hospitals in Scotland during 2021 which were either self-funded by the patient or covered by their medical insurance.

This compares to 1,001 in 2019. 

Knee replacements increased from 654, to 1,573, over the same period. 

HeraldScotland: Source: SAPSource: SAP

HeraldScotland: Tables show (top) number of hip replacements performed in private hospitals, and (above) knee replacements, where patient was paid for by NHS ("NHS independent") or self-funding/insurance ("independent") Source: SAPTables show (top) number of hip replacements performed in private hospitals, and (above) knee replacements, where patient was paid for by NHS ("NHS independent") or self-funding/insurance ("independent") Source: SAP

The average cost of a hip or knee replacement privately in the UK is around £13,000. 

The surge in demand has coincided with a steep reduction in orthopaedic activity on the NHS.

READ MORE: Call to suspend NHS 'back office' functions over winter to free up more time for patients

According to the SAP report, the number of hip replacements - including emergency surgeries on broken joints - was down by 37% per cent to 5,102 in 2021, compared to 8,047 in 2019.

Knee replacements on the NHS were down by 56%, from 7,819 to 3,427.

HeraldScotland: Source: Scottish Arthroplasty ProjectSource: Scottish Arthroplasty Project

By the end of June this year, nearly 2,700 patients on NHS inpatient and day case lists for some form of joint procedure had been waiting over two years - up from just three patients back in June 2019.

A quarter of all the patients waiting over two years are on orthopaedics waiting lists.

Despite the growing demand, however, the number of patients being sent by the NHS to private hospitals for hip and knee replacements in order to cut waiting times has also fallen steeply - from 1,008 in 2019 to 300 last year.

The SAP report also shows that several health boards - including Tayside, Lothian and Dumfries and Galloway - carried out fewer hip and knee replacements last year than they did in 2020, at the height of the pandemic.

READ MORE: More than 35,000 patients waiting over a year for operation on NHS as elective activity stagnates 

Mr Matthew Moran, a consultant orthopaedic surgeon and chairman of the Scottish Arthroplasty Project, said: "The reduction in activity in 2020, as a consequence of the Covid-19 pandemic, has not recovered in 2021 and activity remains well below pre-pandemic levels.

"All health boards across Scotland are working hard to resume activity, however, the challenges from the pandemic remain and some health boards are managing a return towards pre-pandemic activity more successfully than others."

HeraldScotland: Before the pandemic, virtually no patients waited over two years for a hip or knee replacement on the NHS (Source: Public Health Scotland)Before the pandemic, virtually no patients waited over two years for a hip or knee replacement on the NHS (Source: Public Health Scotland)

Unusually, NHS Forth Valley has managed to ramp up orthopaedic activity so much that the total number of joint procedures carried out last year actually exceeded pre-pandemic levels by around a third.

As a result, the total number of people on the region's waiting list for a joint procedure has changed only slightly - from 1,010 in June 2019 to 1,170 by the end of June this year - against a national increase of 119%, to nearly 42,400, over the same period.

At the opposite end of the spectrum, NHS Dumfries and Galloway was able to restore just 17% of its pre-pandemic orthopaedic activity by 2021, and has seen the number of people on its orthopaedics waiting list soar from 427 in June 2019 to 1,079 by the end of June this year.

In 2021, NHS Dumfries and Galloway performed just 65 first-time hip and knee replacements compared to 193 in 2020, and 425 in 2019.

HeraldScotland: The SAP report found wide geographical variation in how well orthopaedics activity has recovered between health boards (Source: SAP)The SAP report found wide geographical variation in how well orthopaedics activity has recovered between health boards (Source: SAP)

However, Mr Moran noted that "despite the challenges of the pandemic" the percentage of patients dying within 90 days of a hip or knee replacement in 2021 was no higher than it had been before Covid.

Meanwhile, NHS bosses are seeking to minimise the impact of Monday's bank holiday on patients. Scotland's largest health board, NHS Greater Glasgow and Clyde, said it is "putting plans in place so that scheduled appointments can continue as planned wherever possible".

NHS Forth Valley said it has "no plans to cancel operations or outpatient appointments" and is "aiming to deliver elective inpatient and day case procedures, as planned".

In some areas, including Lothian and Ayrshire, September 19 was already a local bank holiday.

NHS Grampian said that "all planned care activity – including surgery - will be proceeding as scheduled", with winter vaccination clinics also going ahead.

NHS Borders said elective operations at the Borders General Hospital "will go ahead as planned subject to service pressures", while NHS Highland said "only the most time-critical or high risk" procedures and clinics will go ahead. 

Pam Dudek, NHS Highland Chief Executive, said: “This means that many planned appointments will be cancelled and we will be contacting those impacted directly to make them aware of this, over the coming days.  

"However, some local variation will be expected due to the complexity of the situation and this will be communicated and agreed locally with any patients who are impacted.” 

Ms Dudek added that a majority of GP surgeries, pharmacies and optometrists in the region would be closed for the bank holiday.

NHS Fife said elective surgery will "continue to operate based on clinical priority" but that patients will be contacted directly "if their appointment needs to be rescheduled".

The health board added that flu and Covid vaccination clinics will proceed and that it intends to "retain as many of our outpatient appointments as possible".