Arthroplasty during the COVID-19 Pandemic

North, Trevor; Bullock, Matthew; Danoff, Jonathan R.; Saxena, Arjun; Fischer, Stuart J.; Stronach, Ben M.; Levine, Brett R.

doi:10.1016/j.artd.2020.05.011

Cited by 12 publications

(13 citation statements)

References 14 publications

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“…The infectious disease caused by the novel severe acute respiratory syndrome coronavirus 2 virus (coronavirus disease 2019 [COVID-19]) was declared an international pandemic by the World Health Organization in March 2020[ 1 - 3 ]. In response, a moratorium was declared on the performance of elective surgery in many countries to avert healthcare system collapse, preserve equipment, and maintain resources and hospital capacity[ 4 - 8 ]. Approximately 28 million elective operations were cancelled or postponed worldwide during the peak 12 wk of this global pandemic[ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…In response, a moratorium was declared on the performance of elective surgery in many countries to avert healthcare system collapse, preserve equipment, and maintain resources and hospital capacity[ 4 - 8 ]. Approximately 28 million elective operations were cancelled or postponed worldwide during the peak 12 wk of this global pandemic[ 7 , 8 ]. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures comprise the highest volume of elective procedures performed at health care facilities worldwide[ 4 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Approximately 28 million elective operations were cancelled or postponed worldwide during the peak 12 wk of this global pandemic[ 7 , 8 ]. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures comprise the highest volume of elective procedures performed at health care facilities worldwide[ 4 , 8 ]. A survey of the European Hip Society and the European Knee Associates from 40 different countries reported a near total shutdown of total joint arthroplasty (TJA) with 92.6% of primary TJA procedures being cancelled[ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…A survey of the European Hip Society and the European Knee Associates from 40 different countries reported a near total shutdown of total joint arthroplasty (TJA) with 92.6% of primary TJA procedures being cancelled[ 7 ]. The demand for TJA is already high and waiting lists continue to rise with approximately 150000 elective procedures performed per month in the United States cancelled at some time due to the COVID-19 response[ 3 , 7 , 8 ]. The prolonged postponement of elective TJA has had devastating economic implications on the healthcare system.…”

Section: Introductionmentioning

confidence: 99%

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Pain and function deteriorate in patients awaiting total joint arthroplasty that has been postponed due to the COVID-19 pandemic

Pietrzak

Maharaj

Erasmus

et al. 2021

WJO

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BACKGROUND Elective total joint arthroplasty (TJA) procedures have been postponed as part of the coronavirus disease 2019 (COVID-19) response to avert healthcare system collapse. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures comprise the highest volume of elective procedures performed at health care facilities worldwide. AIM To determine the demand for TJA despite the pandemic and the impact of surgery postponement on physical and mental health. METHODS We conducted a prospective cross-sectional telephonic interview-based study on patients awaiting THA and TKA at an academic institution in South Africa. The questionnaire consisted of four sections. The first section recorded baseline demographic data and medical co-morbidities, the length of time spent awaiting TJA, and the patients’ desire to undergo elective surgery despite the COVID-19 pandemic. Section 2 and Section 3 assessed the patients’ current physical and mental health, respectively, as a consequence of deferred surgical intervention. The last section established the patients’ perception of the healthcare system’s response to the COVID-19 pandemic and necessity to postpone elective surgery. Patients received counseling and education on the current state of surgery during the COVID-19 pandemic and associated risks. Thereafter, patients were once again asked about their desire to undergo TJA during the COVID-19 pandemic. RESULTS We included 185 patients (65.95% female; mean age: 50.28 years) awaiting TJA for a mean of 26.42 ± 30.1 mo. Overall, 88.65% of patients wanted TJA despite the COVID-19 pandemic. Patients awaiting TJA for 1-3 years were 3.3-fold more likely to want surgery than those waiting < 1 year ( P < 0.000). Patients with comorbidities were 8.4-fold less likely to want TJA than those with no comorbidities ( P = 0.013). After receiving education, the patients wanting TJA decreased to 54.05%. Patients who changed their opinion after education had less insight on the increased morbidity ( P = 0.046) and mortality ( P = 0.001) associated with COVID-19. Despite awaiting TJA for shorter period (24.7 ± 20.38 mo), patients who continued to demand TJA had greater pain ( P < 0.000) and decreased function ( P = 0.043) since TJA postponement. CONCLUSION There is deterioration in health for patients, who have had elective procedures postponed during the COVID-19 pandemic. Waiting lists should be prioritized for urgency with the re-initiation of elective surgery.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pain and function deteriorate in patients awaiting total joint arthroplasty that has been postponed due to the COVID-19 pandemic

Pietrzak

Maharaj

Erasmus

et al. 2021

WJO

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“…Expectations of the ‘new normal’ in a COVID-19 world resemble the changes discussed above. A return to elective surgery is expected, starting with simpler operations and gradually adding complex cases ( North et al 2020 ). The literature indicates an emphasis on precaution and diligence to accompany the resumption of elective surgery, with assessment of COVID-19 patient symptom status on the day of surgery likely to become common.…”

Section: The Future In a Covid-19 Worldmentioning

confidence: 99%

The orthopaedic experience of COVID-19: A literature review

Al-Kulabi

Mansour

Thahir

2021

Journal of Perioperative Practice

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This literature review aims to provide an account of the changes to orthopaedics in the era of COVID-19. Herein, the authors explored the use of telemedicine in orthopaedics as well as changes in surgical protocols, screening methods, work priorities and orthopaedic education. There was increased utilisation of telemedicine in orthopaedic training and outpatient cases as a means to provide continuity in education and care. The need to implement social distancing measures, coupled with the reduced availability of staff, has dictated that the practice of orthopaedics shifts to focus on acute care whilst redistributing resources to front-line specialities. This was facilitated by the cancellation of electives and the reduction of outpatient clinics. Thus, it is demonstrated that major changes have been implemented in many aspects of orthopaedic practice in order to address the challenges of the COVID-19 pandemic.

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Incidence of Symptomatic COVID-19 in Unvaccinated Patients Within One Month After Elective Total Joint Arthroplasty: A Multicenter Study

et al. 2022

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Background The safety of continuing Total Joint Arthroplasty (TJA), as an elective procedure, during the pandemic is controversial. The present study aimed to investigate the incidence of symptomatic COVID-19 and its related risk factors in unvaccinated patients after TJA within one month post-discharge in two large cities of our country. Methods The present prospective study included all the patients admitted to three hospitals, located in two high-populated cities of our country from April 1st, 2020, to April 1st, 2021, for elective TJA. Urgent TJA (traumatic fractures) were excluded. The primary outcome was symptomatic COVID-19 within one-month after discharge that was diagnosed using the SARS-CoV-2 RT-PCR test. Afterward, the incidence of the COVID-19 in the study population was compared with the general population to estimate the safety of elective TJA during the pandemic. Results From the 1007 patients undergoing TJA, 755 patients met the inclusion criteria. None of the patients was vaccinated against COVID-19. Among them, 18 patients (2.4%) developed symptomatic COVID-19 within one-month after discharge. In the same time interval, the incidence of COVID-19 was 2.2% in the general population of these two cities, which was similar to the incidence reported in the study population. Of the patients who were positive for COVID-19, four patients were hospitalized, and 3 of them were ICU-admitted; however, no mortality was reported. Conclusion The TJA will be a safe elective procedure for the patients during the pandemic if the preventive protocols are followed strictly.

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Arthroplasty during the COVID-19 Pandemic

Abstract: This article aims to give a brief outline of the pathogenesis and transmission of SARS-CoV-2 and how to safely navigate an arthroplasty practice during and after the pandemic.

Cited by 12 publications

References 14 publications

Pain and function deteriorate in patients awaiting total joint arthroplasty that has been postponed due to the COVID-19 pandemic

Pain and function deteriorate in patients awaiting total joint arthroplasty that has been postponed due to the COVID-19 pandemic

The orthopaedic experience of COVID-19: A literature review

Incidence of Symptomatic COVID-19 in Unvaccinated Patients Within One Month After Elective Total Joint Arthroplasty: A Multicenter Study

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