Why Are 780,000 People Waiting for a Hip or Knee Replacement?

Hip and knee replacements are among the most common elective surgeries in England, and among the most life-changing. For the roughly 200,000 people who received one each year before the pandemic, the operation typically meant the end of years of worsening pain and the return of basic mobility — climbing stairs, walking to the shops, sleeping through the night.^[2] The NHS waiting list for these two procedures alone now stands at 780,000, a figure that has more than quadrupled since 2019.^[1] The median wait has stretched from under 15 weeks to over a year. For patients in the South West, it is closer to 14 months.^[1]

The collapse began in March 2020, when all non-urgent elective surgery was suspended to free hospital capacity for COVID-19. In the first year of the pandemic, hip and knee replacements fell by 60% — from 195,000 annual procedures to just 78,000.^[2] The backlog that had been building slowly for years became an avalanche. Orthopaedic theatre capacity has still not fully recovered: infection control measures reduced the number of operations per session, staff shortages have constrained lists, and the independent sector — which now performs around a third of NHS-funded joint replacements — cannot absorb the scale of unmet demand. The 2022 Elective Recovery Plan pledged to eliminate waits over 18 months, but the 18-week standard that patients were once entitled to expect has become a distant memory.^[5]

The human cost is not abstract. Research published in the BMJ found that patients who wait more than six months for joint replacement experience measurable deterioration — muscle wasting, weight gain from immobility, worsening mental health, and increased use of opioid painkillers.^[3] Around one in five patients waiting over a year report that they have had to leave work or reduce their hours.^[3] The National Joint Registry data shows that patients who wait longer have worse post-operative outcomes and higher revision rates.^[4] There is one significant positive development: procedure volumes in 2025 have exceeded pre-pandemic levels for the first time, reaching an estimated 198,000 operations.^[2] If sustained, this rate should begin to reduce the backlog — but at current volumes, clearing the accumulated list would take several years even if no new patients were added.