Evidence map›Paper›PMID 41088116›Full record

ArticleBMC medicine2025

Trends in hip and knee replacement length of stay and patient demographics in England: a population-based study of 1,455,842 primary procedures.

Jonathan M R French, Kevin Deere, Adrian Sayers, Michael R Whitehouse

Abstract read
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In one paragraph

Article in BMC medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Jonathan M R FrenchMusculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, University of Bristol Medical School, Bristol, BS7 0UL, United Kingdom. Jonathan.french@bristol.ac.uk.
Kevin DeereMusculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, University of Bristol Medical School, Bristol, BS7 0UL, United Kingdom.
Adrian SayersMusculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, University of Bristol Medical School, Bristol, BS7 0UL, United Kingdom.
Michael R WhitehouseMusculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, University of Bristol Medical School, Bristol, BS7 0UL, United Kingdom.

Funding

Orthopaedic Research UK / British Hip Society 568
6 · The paper itself

Abstract

backgroundLength of stay (LOS) after hip and knee replacement has decreased steadily in the modern era with enhanced recovery protocols, enabling healthcare systems to address rising surgical demand in an ageing, comorbid population. This study examines trends in LOS, patient characteristics, and their associations for NHS-funded procedures in England, covering a period that includes the COVID-19 pandemic.

methodsData from the National Joint Registry and Hospital Episode Statistics were linked to identify patients who underwent primary total hip replacement (THR) and total or unicompartmental (partial) knee replacement (TKR/UKR) in England between January 2010 and March 2022. LOS was analysed using flexible parametric models to estimate median values over time, with subsequent adjustment to examine associations between changing patient characteristics. Trends in 30-day readmission rates were also analysed.

resultsFrom 2010 to 2022, median LOS decreased from 4.26 days (95% CI 4.22 to 4.30) to 2.75 days (95% CI 2.74 to 2.77) for THR, from 4.35 days (95% CI 4.32 to 4.39) to 2.91 days (95% CI 2.90 to 2.92) for TKR, and from 3.2 days (95% CI 3.16 to 3.25) to 1.91 days (95% CI 1.89 to 1.95) for UKR. Variability also decreased. There were no increases in crude 30-day readmission rates. Trends in patient demographics showed increasing comorbidity, obesity, male sex, affluence, and use of the independent sector, all of which were associated with LOS and had the overall effect of slightly attenuating its reduction. Significant changes in patient characteristics occurred around the time of the COVID-19 pandemic but have since resumed previous trends.

conclusionsPatients in England now typically stay fewer than three days for total hip or knee replacement and under two days for partial knee replacement. Despite demographic trends towards characteristics associated with longer LOS, reductions have occurred independently of these changes, suggesting potential for further shortening. However, as these diverging trends continue, ensuring equitable access to surgery will be increasingly important.

Indexed as

Arthroplasty, Replacement, HipArthroplasty, Replacement, KneeLength of StayAgedAged, 80 and overCOVID-19EnglandFemaleHumansMaleMiddle AgedPatient ReadmissionRegistriesSARS-CoV-2ArthroplastyCharacteristicsDemographicsHip replacementHospital stayInpatient stayJoint replacementKnee replacementLength of stayTrends

Identifiers

PMID41088116
PMCPMC12522415

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.