Author summary Why was this study done? Joint replacements are among the more frequent elective surgeries performed in developed settings. In England, inequalities in provision of joint replacement surgery were reported more than a decade ago, followed by a national effort to reduce these inequalities. In a context of increasingly strained National Health Service funding and hospital budgets, alongside prolonged efforts to increase surgical capacity, it is unclear what impact these have had on inequalities in provision of joint replacement for osteoarthritis. What did the researchers do and find? We conducted an analysis of the National Joint Registry using all primary hip and knee replacements for osteoarthritis performed from 2007 to 2017 in England, merged with the Office for National Statistics official population statistics, to investigate inequalities in provision of surgery according to deprivation by patient area of residence, age, sex, and trends in these inequalities over time. Using 675,342 primary hip and 834,146 primary knee replacements, we found that inequalities in provision of surgery between the most (reference) and least affluent areas have remained large (hip: rate ratio (RR) = 0.58, 95% confidence interval [0.56, 0.60] in 2007, RR = 0.59 [0.58, 0.61] in 2017; knee: RR = 0.82 [0.80, 0.85] in 2007, RR = 0.81 [0.80, 0.83] in 2017), despite the use of outsourcing of surgery to the private sector. For hip replacement, Clinical Commissioning Groups (CCGs) with the highest concentration of deprived areas had lower overall provision of surgery, and CCGs with very few deprived areas had higher surgical provision. There has been an overall improvement in the absolute numbers of hip and knee replacement operation being performed; there is now less geographical variation in rates of surgery. For publicly funded surgery, no socioeconomic inequalities were observed for knee replacements, with a smaller inequality observed for hip replacements, whereas for privately funded surgery, strong inequalities were observed for both joints. What do these findings mean? This study found that socioeconomic inequalities in provision of joint replacement surgery are still prevailing. Care providers should take action to address unwarranted variation in the provision of joint replacement surgery.