Complete guide to NHS orthopaedic services in the UK — joint replacement waiting times, National Hip Fracture Database (NHFD), enhanced recovery, day case orthopaedics, and orthopaedic software.
The NHS orthopaedic waiting list is 700,000+ patients, with 20% waiting over 52 weeks. 70,000 hip fractures per year are tracked through NHFD. This guide covers orthopaedic services and improvement.
NHS Orthopaedic Service Components
| Service | Description | Waiting Time Target |
|---|---|---|
| Elective orthopaedics OPD | Outpatient orthopaedic consultations | 18 weeks RTT |
| Joint replacement | Hip, knee, shoulder replacement | 18 weeks RTT |
| Arthroscopy | Keyhole joint surgery | 18 weeks (day case) |
| Spinal surgery | Elective spinal procedures | 18 weeks RTT |
| Trauma orthopaedics | Fracture management | Urgent (same day) |
| Hip fracture | Neck of femur fracture repair | Surgery within 36 hours |
| Orthopaedic rehab | Post-surgery rehabilitation | Within 7 days of discharge |
NHFD Key Metrics
| Metric | Target | National Average |
|---|---|---|
| Surgery within 36 hours | 85% | 82% |
| Orthogeriatric assessment | 95% | 90% |
| Bone protection medication | 90% | 85% |
| Mobilisation day after surgery | 80% | 75% |
| 30-day mortality | < 6% | 6.1% |
| Return to original residence | 80% | 75% |
| Delirium screening | 95% | 80% |
Enhanced Recovery for Joint Replacement
- Pre-operative: Patient education, optimisation (Hb, nutrition), pre-assessment
- Day of surgery: Carbohydrate loading, no prolonged fasting, regional anaesthesia
- Surgery: Minimally invasive where possible, tranexamic acid, local infiltration
- Post-operative: Early mobilisation (within 4h), multimodal analgesia, avoid opioids
- Discharge: Standardised discharge criteria, typically 1-3 days for hip, 2-4 for knee
- Follow-up: PIFU or virtual review at 6 weeks, patient-reported outcomes (PROMs)
Frequently Asked Questions
- How long is the NHS waiting list for joint replacement?
- The NHS waiting list for hip and knee replacement is 700,000+ patients. Average wait: 40-60 weeks. Target: 18 weeks RTT. 20% of patients wait over 52 weeks. NHS England targets eliminating 52+ week waits by 2026 through surgical hubs and private sector capacity.
- What is the NHFD?
- The NHFD (National Hip Fracture Database) is the national audit for hip fracture care. It measures: time to surgery, orthogeriatric assessment, bone protection medication, mobilisation, and 30-day mortality. 70,000 hip fractures per year in the UK. NHFD has improved 30-day mortality from 8% to 6% since 2007.
- What is the NHS day case rate for orthopaedics?
- NHS targets 75%+ of eligible orthopaedic procedures as day cases. Current rate: 65%. Procedures suitable for day surgery: arthroscopy, carpal tunnel release, ganglion excision, bunion surgery. Day case orthopaedics costs 40-60% less and frees inpatient beds.