Prioritising elective arthroplasty: a further challenge of COVID-19 Can a prioritisation scoring tool help with reducing waiting lists?

The COVID-19 pandemic has had a significant impact on the delivery of elective orthopaedic care in the UK, leading to a hugely increased number of patients on waiting lists. The focus has therefore now turned to reducing the backlog. We sought to develop a clear, objective and reproducible system for prioritising elective hip arthroplasty. The prioritisation scoring system was constructed using the Federation of Surgical Specialty Associations (FSSA) guidelines as a framework. This included current Oxford hip scores, review of imaging, waiting list duration and previous cancellations. The inter-rater and intra-rater reliability for the final prioritisation scores was tested using the Kappa statistic by two blinded surgeons independently reviewing a selection of patients on two separate occasions. A random sample of 20 scores from 125 of the 136 patients on the waiting list were included in the study. The level of prioritisation was assessed by two consultant surgeons. No statistically significant intra-rater or inter-rater reliability was demonstrated. Developing an equitable hip arthroplasty prioritisation system is an essential but challenging task. This scoring system was designed as an objective means of determining prioritisation for the elective arthroplasty waiting list within the FSSA categories of priority 3 and 4. Further refinement in light of the evolving guidelines will allow improved reliability.