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The variation in case-mix of patients admitted for routine (non-emergency) orthopaedic surgery at a Staffordshire orthopaedic hospital over a 10-year period was studied, with the aid of the BUPA Schedule of Surgical Procedures. Over this period there was a 2% decrease in the total number of operations performed. There was a marked reduction in the number of 'minor' operations performed, and a marked increase in the number of 'major' and more complex operations performed. The overall workload, as judged by estimated surgeons' fees, rose by 43%. This study offers clear support to the claim that the complexity of orthopaedic operations performed has significantly increased over a ten-year period.