Arthroplasty Should Be Considered ‘Essential Surgery’ Due to Global Disease Burden

Musculoskeletal conditions are among the largest contributors to disease burden in the U.S. and worldwide. As communicable diseases like HIV, tuberculosis and malaria have become better controlled and life expectancy has increased globally, musculoskeletal conditions like osteoarthritis have become the world’s second leading cause of years lived with disability.

Despite this, arthroplasty currently is not considered “essential surgery.” In 2015, when the World Bank Disease Control Priorities project listed 44 essential surgical procedures for which to improve access in low- and middle-income countries, arthroplasty didn’t make the list.

“Essential surgeries are those that address a substantial need, are cost-effective and are feasible to implement around the world,” explains Nicolas S. Piuzzi, MD, an orthopaedic surgeon at Cleveland Clinic. “While injury-related orthopaedic procedures, such as fracture reduction, have been deemed essential, joint replacement has not. That is an opportunity, considering how much arthroplasty could help reduce the global burden of disease.”

Given the rising demand for musculoskeletal care, it might be time to update the list of essential surgical procedures, he says.

Dr. Piuzzi and Cleveland Clinic orthopaedic surgery resident Peter Delaney, MD, recently called for inclusion of arthroplasty as essential surgery in a statement published in the Bulletin of the World Health Organization.

“Our call is for arthroplasty to be formally recognized within global essential surgical care frameworks, which help guide health policy, surgical system planning, workforce development and resource allocation worldwide,” Dr. Piuzzi says.

Cost-effective and feasible to implement worldwide

In their statement, Drs. Piuzzi and Delaney assert that hip and knee arthroplasty should be considered essential surgery because it is:

Cost-effective. Surgery is increasingly seen as a cost-effective public health intervention. Although cost-effectiveness varies by procedure, orthopaedic surgery compares favorably to medical treatments for chronic heart disease and HIV. Elective hip and knee replacements provide substantial improvement in long-term quality of life, with total hip arthroplasty generally being slightly more cost-effective than total knee arthroplasty.

Although expanding arthroplasty services globally would be expensive, say the authors, doing so may generate major economic benefits by reducing disability and improving productivity. Arthroplasty in particular can help patients return to work and reduce long-term assisted living costs.

Feasible to implement worldwide. Arthroplasty produces reliable, long-lasting results because it follows well-established clinical pathways. These pathways can support reproducible, scalable implementation globally.

“Obviously trauma remains the leading source of morbidity and mortality in low- and middle-income countries, but we seek to highlight that in the decade since the World Health Assembly declared surgery essential, the world has changed,” Dr. Delaney adds. “With improved control of communicable diseases, the lifespan in low-income countries has dramatically increased, and the noncommunicable disease burden from chronic conditions like musculoskeletal disorders now outweighs that of communicable diseases. This suggests that the global surgery community should reconsider arthroplasty in capacity-building efforts.”

In high-income countries, primary hip and knee replacements have increasingly moved to outpatient settings with same-day discharge. Adopting similar outpatient models in low- and middle-income countries may reduce pressure on limited inpatient resources, say the authors.

Furthermore, as patents expire, generic orthopaedic implants modeled on proven existing designs may help lower costs and improve access to hip and knee arthroplasty wherever access to newer implants is limited.

Transformative impact of orthopaedic care

Musculoskeletal disability is a major and often overlooked global health issue, contends Dr. Piuzzi.

“It disproportionately affects low- and middle-income countries, where access to joint replacement remains extremely limited despite its profound impact on restoring mobility, independence and quality of life,” he says. “Our statement is intended to raise awareness of this issue and the transformative impact of arthroplasty.”

Read the full article by Drs. Piuzzi and Delaney in the April 2026 Bulletin of the World Health Organization.