A critical packaging fault at the NHS’s primary supplier of bone cement has forced hospitals to postpone thousands of planned hip and knee replacements, prioritising only the most urgent cases amid a supply crisis expected to last up to two months.
Heraeus Medical, the German-based company which supplies approximately three-quarters of the bone cement used by the NHS, has temporarily halted production at its main site. The issue, affecting 17 product codes, involves a fault where the secondary packaging bag may tear, compromising the sterile removal of the inner bag and leading to the destruction of inventory. Full production is not anticipated to resume for at least eight weeks.
Immediate impact on patients and waiting lists
NHS England has issued immediate guidance to hospital trusts, instructing them to direct existing stocks to trauma and urgent care while prioritising orthopaedic waiting lists based on clinical need. Officials estimate only two weeks of supply remains within the system, with a gap of six to eight weeks anticipated.
The scale of the disruption is substantial, affecting approximately 1,000 NHS operations per week. Primarily knee replacements, but also some hip and shoulder procedures, rely on this specific cement, meaning around 10,000 planned surgeries could be delayed over the two-month period. This is a severe blow to an orthopaedic waiting list that is already the largest in England, with around 850,000 patients awaiting treatment. Within that total, over 31,000 people are waiting for a hip replacement and nearly 50,000 for a knee replacement, with average waits exceeding six months in many areas.
Deborah Alsina, chief executive of Arthritis UK, described the news as a “crushing blow” for those who have already endured long waits. “We trust the Department of Health and Social Care will work hard to address the supply issues given the impact on those waiting in pain whose lives are left on hold,” she said. The charity is offering support through its helpline and online community.
Caroline Abrahams, charity director at Age UK, said many older people with surgeries scheduled in the coming months face postponement. “We sincerely hope that the NHS will be able to reschedule their operations speedily, once bone cement supplies have recovered,” she added.
National scramble for alternatives
In response, a national effort coordinated by the Department of Health and Social Care, NHS England, and NHS Supply Chain is underway to identify alternative suppliers and products, with the British Orthopaedic Association assisting. Daily incident coordination meetings and weekly customer webinars are being held to manage the situation, and trusts have been asked not to contact suppliers directly.
Hospitals have also been advised to utilise released theatre time for orthopaedic procedures that do not require bone cement. However, mitigation efforts are complicated by the fact that bone cement requires temperature-controlled cold chain logistics for stability, a service NHS Supply Chain is not commissioned to provide.
Bone cement, formally known as Polymethyl Methacrylate (PMMA) cement, is used to anchor artificial joints in procedures like hip and knee replacements—tens of thousands of which are performed in England annually—and also has applications in other orthopaedic and dental surgeries.
Underlying vulnerabilities exposed
This incident highlights structural vulnerabilities in NHS supply chains, particularly the service’s reliance on a single dominant supplier for critical materials, a lesson echoed from pandemic-era shortages. Heraeus Medical has experienced previous packaging issues with its bone cement products dating back to 2018, which also affected sterility.
The global bone cement market is substantial, with PMMA cement holding a dominant share, and Heraeus is a major player within it. While national contingency planning guidance exists for managing medicines supply issues, the current shortage involves a medical device consumable, presenting distinct challenges.
Rory Deighton, acute and community care director speaking for NHS Providers and the NHS Confederation, said health leaders would work to minimise the impact. “People should come forward for treatment as planned unless they are told otherwise by their trust,” he stated.
