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Thousands of NHS knee replacement operations are cancelled at short notice every year, many for avoidable reasons, according to a new study. This costs the NHS millions of pounds and increases waiting times for patients, many of whom are in severe pain.

The study was led by researchers at the University of Bristol’s National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre (BRC) in collaboration with investigators from Nottingham BRC’s MSIR Theme, and published in The Bone & Joint Journal.

The NIHR-funded study collected information on the timing of - and reasons for - cancellation of total knee replacement surgery at six NHS hospitals in England, Scotland, Wales and Northern Ireland, over a period of five years between April 2018 and March 2023.

The study found that, at the six hospitals over the five years, 17,223 total knee replacement operations were completed and 9,403 cancelled – more than previously thought.

This is the first study to measure total knee replacement cancellations across more than one hospital and authors of the paper include Mr Tom Kurien, Clinical Associate Professor of Orthopaedics and specialist consultant knee surgeon in Nottingham, who is also a member of the Nottingham BRC MSIR Theme.

"Aim for zero avoidable cancellations"

He said: "Avoiding cancellations of knee replacement surgery in the UK is vital because every delay prolongs pain, limits mobility, and impacts a patient’s independence. When procedures proceed as planned, patients move more quickly towards recovery, reducing the risk of worsening joint damage and improving overall quality of life.

‘’Minimising cancellations also protects valuable NHS resources, ensures theatre time is used efficiently, and supports staff in delivering consistent, patient-centred care. Every successful, timely operation represents a step toward restored confidence, comfort, and long-term wellbeing.”

Mr Kurien added: "‘This important My Knee Plan study has highlighted that overall, 25% of all knee replacements in the UK are cancelled at very short notice, often due to capacity issues or patient related medical concerns which could have been addressed earlier.

‘‘As an organisation, we should aim for zero avoidable cancellations and studies like this are vital to identify the scale of the problem nationally. Identification of the root causes of these unnecessary cancellations is essential if we are to drive up standards in the NHS.’’

Cost of cancelled operations

Each cancelled operation costs the NHS a lost tariff of between £6,500 and £11,000. This adds up to over £15.5 million across the six hospitals, over five years.

A quarter of the cancellations were less than 24 hours before surgery, and nearly one third were within two to 14 days. Cancellations the day before, or on the same day as surgery, can leave empty operating theatre spaces which are difficult to fill. Rescheduling these operations adds to already lengthy NHS waiting lists.

Cancelled surgery and increased waiting times can reduce patients’ quality of life and leave them feeling rejected. Patients on the waiting list experience a significant decrease in quality of life after six to 12 months of waiting for total knee replacement surgery – a quarter say they are waiting in a state “worse than death”, according to previous studies.

Lack of available hospital beds and patients being unfit for surgery were the most common reasons for short-notice cancellations. Many of these cancellations could have been avoided with advance planning.

Heart problems, infections and wounds were the main health reasons for cancelling surgery. With the right medical care while people wait for their operation, many patients could be supported to be medically fit for surgery, and cancellations avoided.

The scale of this problem is huge. Knee replacements are one of the most common types of surgery, with over 110,000 total knee replacements performed yearly in the UK. More than three million people are currently waiting more than eighteen weeks for non-urgent NHS surgery.

Efficiency programmes are required

This highlights an urgent need for efficiency programmes in the NHS, and UK-wide healthcare planning for patients on waiting lists, to prevent cancellations.

Dr Mark Eveleigh, Consultant Anaesthetist at Gloucestershire Hospitals NHS Foundation Trust, said: “Cancelled operations aren't just about wasted resources. Each cancellation statistic represents a patient who has often uprooted their entire life to get into hospital, followed the preparation advice to the letter, arranged transport and found someone to look after loved ones, frequently at great cost to themselves.

“So for us then not to do the operation after they have gone through all that is, in my mind, unforgivable.

“We should strive for zero avoidable cancellations, and projects like this are the first step to realising that across the NHS. Until we know what drives cancellations, we cannot realistically expect them to simply stop happening.”

Peter Aitken, patient and public contributor involved in the research, said: “My knee replacement operation was originally booked for November 2023, but was cancelled after my pre-op appointment because of blood-thinning medication I was taking at the time.

“It was rescheduled for March 2025 and I attended hospital on the day. But, after a wait of seven and a half hours, when I was ready with my gown on, I was told at the eleventh hour that the operation would have to be cancelled because they ran out of time.”