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. 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 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.