Orthopaedic surgeons say it may be impossible to ever "catch up" on all the operations delayed due to the Covid-19 restrictions.
They are warning some patients have waited too long already and may suffer life-long effects.
Auckland District Health Board was unable to say how many appointments and surgeries were cancelled due to the most recent lockdown, but it confirmed that elective operations during level 4 were only about 40 percent of usual, compared with the same period last year.
Orthopaedic surgeon Peter Robertson said at Auckland Hospital, they had only been doing the most severe cases.
However, patients who were stuck at home in pain ended up costing the health system more in the long run, he said.
"There's little doubt that the longer you are immobilised, people get sicker, they get less physically active, their ability to rehabilitate to the optimum position that they might have had if they had had their intervention at an earlier stage is much less.
"It has a flow-on effect."
While the number of operations performed went up every year, they were mainly acute or emergency - and the number of elective procedures had been dropping, even before Covid-19, he said.
"The concept that the backlog could be 'caught up' is a false concept. There is not staff across every level of the hospital, there's not the beds and there's not the infrastructure to do that."
During Auckland's five weeks of lockdown, Counties Manukau District Health Board was forced to cancel around 5000 outpatient appointments and more than 1150 elective operations.
At Waitematā District Health Board, 150 operations a week had to be cancelled under alert level 4 and the entire 40-bed Elective Surgery Centre at North Shore Hospital was converted into a Covid-19 ward.
The Orthopaedic Association president, Wellington surgeon Peter Devane, said Covid-19 had complicated what was already "an under-resourced system".
"The Ministry of Health I'm sure will acknowledge this: there is no such thing as 'catch up' any more. We are not able to catch up, orthopaedic surgery is never going to be able to catch up, and that phrase needs to be deleted from our vocabulary, simply because there is no capacity to do that."
Last year, the government allocated district health boards an extra $282.5 million over three years to clear the backlog of deferred elective operations.
However, Devane said public hospitals were at nearly 100 percent capacity before the pandemic.
"Who's going to do it? That's my question. We don't have the staff, the capacity, the theatres, the surgeons, the nurses, the anaesthetic technicians, the ward nurses, ED docs, or anyone else who can do it.
"You look at our situation where everyone is doing pretty much everything they can do, and there's no-one else you can call on who can call on to catch up."
Deferrals 'not right answer'
Private Surgical Hospitals Association chief executive Richard Whitney said they had learned from the previous lockdown that deferring everything was "not the right answer" and some elective procedures had continued, even under level 4.
He was hopeful therefore that the impact from the latest restrictions would not be as bad as last year - but admitted the increased wait times meant some patients' conditions would have deteriorated.
"Elective surgery still has elements of priority. There are certainly consequences for patients where deferrals or lag-times extend beyond what is best indicated, and the outcomes for some patients who are deferred will be sub-optimal."
So with the public system stretched beyond capacity and less flexibility in the private system to pick up the slack, what is the solution?
Auckland surgeon Peter Robertson said there was something every New Zealander could do.
"Vaccination should be essentially compulsory. We will not keep people out of hospital if they are unvaccinated.
"Even if we get to the high levels of vaccination that we're aiming for - 90 percent - the numbers I have seen would suggest that among unvaccinated people, the percentage of them that got sick would still swamp our system."
As Britain, Australia and the United States have already experienced, that would be "the killer blow" to anyone getting elective surgery in New Zealand, Robertson said.