A shortage of training places for orthopaedic surgeons must be addressed as demand for hip and knee replacement surgery continues to rise, the Royal College of Surgeons has said.

The RCS has analysed data on operations from the Health and Social Care Information Centre covering 2013-14, which has been shared with HSJ.

Hip replacement surgery saw its biggest increase in three years, with a 4.7 per cent rise in activity rates in 2013-14.


Knee replacement surgery is up 3.3 per cent on 2012-13

Knee replacement surgery continued to increase and operations were up 3.3 per cent on 2012-13.

Stephen Cannon, orthopaedic surgeon and RCS vice president, told HSJ the number of training posts was “limited” and had reduced over recent years.

He said: “It’s well known that if you look at incidents of orthopaedic surgeons for the population we’re not exactly the best supplied in Europe. The UK generally has one surgeon in every 25,000 people. These are major differences compared to Sweden, Denmark and all the other [countries in western] Europe.”

He added that while there would be “no problems” in finding enough doctors to fill training positions, posts were limited.

Mr Cannon said: “It would have to be addressed over a period of 10 years and the number of training posts has not really altered, and in fact has been diminished in terms of surgical numbers in recent years. It isn’t being addressed.”

Bariatric surgery had dropped by 21.8 per cent since 2011-12, despite obesity remaining a national health issue. Mr Cannon said, however, there may be some problems with the data recording.

He said: “I would find it difficult to believe that the number requiring bariatric surgery is going down, so either there’s a statistical error or there is some problem with getting commissioning or local authorities responsible for commissioning into the system.”

The analysis also suggested there has previously been confusion between the NHS and local authorities over who should commission weight loss services that patients attend before undergoing surgery. This is “likely” to have had a “detrimental impact” on the number of patients accessing surgery during 2013-14, the RCS said.

Amputations steadily increased over a 10 year period up to 2013-14. However, while amputations among men went up by 8.9 per cent that year, they fell by 0.8 per cent among women.

Tonsillectomy operations dropped by 10 per cent between 2007-08 and 2011-12, but by 2013-14 had increased again by 7.9 per cent.

Mr Cannon said an ageing population has created a growing demand for elective care and this was putting strain on clinicians.

He added: “The vast majority of surgeons in the NHS are working flat out. It is a very rare event that you would find a surgeon who doesn’t have a full waiting list and a full operating list.”