LAUSR

Joint replacement (JR) is one of the most common and successful surgical procedures performed in Australia, with over 115 000 primary procedures undertaken in 2019. In 2020, most JR surgery was suspended in late March in response to Federal Government directives to allow only emergency and urgent surgery, which did not include elective JR. This suspension was gradually eased over subsequent months, which varied by jurisdiction. The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) is uniquely positioned to monitor the impact of COVID-19 related restrictions on JR surgery across the country. AOANJRR data indicates that 5503 fewer primary hip, knee or shoulder replacements for OA (which excludes traumarelated replacements) were conducted nationwide in 2020 compared to 2019. As expected, the largest reduction occurred in April, with a 83.7% reduction in primary JRs due to OA compared to April 2019, equating to 6035 procedures (Fig. 1). June and July 2020 saw a rebound in the number of primary JRs for OA, increasing by 13.3% compared to the same period in 2019 (Fig. 1). The impact of COVID-19 varied by State or Territory throughout the year (Fig. 2). In Victoria, a second-wave resurgence of COVID-19 led to elective surgery being temporarily re-suspended in July 2020 with a staggered reintroduction thereafter. Not surprisingly, Victoria experienced the largest reduction in JR; primary JR due to OA was down 4338 procedures (19.3%). In contrast, Tasmania, ACT and Queensland increased primary JR in 2020, principally due to substantial increases in activity in the second half of the year. In addition to reductions in primary JR, the COVID-19 pandemic was associated with a major decline in revision replacement surgery, which is most commonly required for prosthetic loosening, fracture, instability/dislocation and infection. AOANJRR data demonstrate that 1349 fewer hip, knee or shoulder revision procedures occurred in Australia in 2020, representing a 13.0% decrease from 2019. Hip replacements for fracture were 101 fewer for 2020, a modest 1.2% reduction. Contrary to other types of JR, shoulder