Background: COVID-19 has caused unprecedented delays in elective orthopedic surgery. Understanding patients' perceptions of the disruptions in care and their willingness to reengage the healthcare system are crucial to planning the resumption of elective care. Questions/ Purposes: The purpose of this study was to elicit patient perceptions about delays in total joint arthroplasty during the COVID-19 pandemic. Methods: We identified a consecutive series of patients who experienced COVID-19-driven delays to scheduled total hip or knee arthroplasty at an urban, academic medical center in the Southeastern United States. A 20-item survey was administered via telephone. Answers were recorded and descriptive statistics were performed. A post hoc χ-square analysis compared characteristics and outlooks of patients who did and did not immediately desire surgery. Results: Of 111 patients (64% of those identified) who met inclusion criteria and completed the survey, 96% said they felt that they were treated fairly and 90% said that the surgical delay was in their best interest; 68% reported emotional distress from the delay, but 45% reported a desire to wait longer for the pandemic to subside. Lower jointfunction scores, higher pain levels, higher pain catastrophizing scores, and longer latency from personally deciding to pursue surgery were associated with the reported need for immediate surgery. Conclusion: Overall, patients reported that they understood the need for elective surgical delays during the COVID-19 pandemic. However, the psychological implications they reported were not negligible. Patient preference for immediate reengagement with the healthcare system was dichotomous, with many patients favoring precautionarily furthering the delay. Understanding these preferences will help optimize elective orthopedic care during unprecedented times.

Costal cartilage grafting is a commonly used reconstruction procedure, particularly in rhinoplasty. Although costal cartilage is broadly used in reconstructive surgery, there are differing opinions regarding which costal cartilage levels provide the most ideal grafts. Grafts are typically designed to match the shape of the recipient site. The shapes of costal cartilage grafts have been described as “boat-shaped,” “C-shaped,” “canoe-shaped,” “U-shaped,” “crescent-shaped,” “L-shaped,” “semilunar,” “straight,” and “Y-shaped.” The shapes of costal cartilages are thought to lend themselves to the shapes of certain grafts; however, there has been little study of the shapes of costal cartilages, and most reports have been anecdotal. Therefore, this study is aimed to detail the average shapes of the most commonly grafted cartilages (i.e., the fifth to seventh cartilages). A total of 96 cadaveric costal cartilages were analyzed through geometric morphometric analysis. The fifth costal cartilage was determined to have the straightest shape and would therefore be particularly suitable for nasal dorsum onlay grafting. The lateral portions of the sixth and, particularly, the seventh costal cartilages have the most acute curvature. Therefore, they would lend themselves to the construction of an en bloc “L”-shaped or hockey stick-shaped nasal dorsum-columellar strut graft.

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