The silver tsunami and the elective arthroplasty crisis: How geriatric trauma overruns public surgical capacity

Across Europe, orthopaedic departments face a growing disequilibrium: the sharply rising volume of geriatric trauma requiring urgent intervention versus the continued necessity for high-value elective total joint arthroplasty to restore mobility, independence and quality-adjusted life years (QALYs). In most public systems, the escalation in proximal femoral fractures—driven by demographic shifts —absorbs operative capacity previously allocated to elective arthroplasty. Although trauma surgery should, by definition, be prioritised, the resulting displacement of elective total joint arthroplasty (TJA) increasingly undermines the principles of value-based care. This editorial discusses the drivers of this development, highlights the clinical and health-economic consequences and outlines practical strategies that European health systems should consider to maintain timely trauma care without sacrificing access to elective arthroplasty.