Assessing the Attitudes, Awareness, and Behavioral Alterations of Patients Awaiting Total Hip Arthroplasty During the COVID-19 Crisis

Abstract

Background: COVID-19 has placed a huge burden on healthcare systems which has led to widespread cancellation elective surgical care. Ireland is recovering from the first wave of COVID-19 and as such the expeditious return of elective surgical care is important. This is the first study to examine the attitudes of patients to undergoing total joint arthroplasty during the COVID-19 crisis. Methods: A prospective qualitative study was undertaken in our institution during the week 13/05/2020-20/05/2020. 65 patients completed a questionnaire assessing attitudes, awareness, and behavioral changes associated with COVID-19, a Charlson Comorbidity Index, modified-Harris Hip Score, and a Short Form-12 score. Results: 86% of patients felt that they were at little to no risk of COVID-19 infection. The majority of patients were happy to proceed with surgery at the current level of COVID-19 related threat (86%). Patients with higher mHHS were more likely to postpone their operation than those with lower mHHS scores. Our cohort had low patient reported outcome measures in both mHHS and SF-12, indicating the significant burden of hip osteoarthritis on both physical and mental health. Conclusion: Patients reported a significant disease-related impairment of physical function and subsequent deterioration in mental health as a result of hip osteoarthritis. Patients with worse hip function, as measured by the mHHS are more willing to proceed with surgery than those with superior hip function. This offers a potential mechanism by which to triage patients once elective surgical pathways reopen in the coming months.

The Effect of the COVID-19 Pandemic on Total Hip and Knee Arthroplasty Surgical Volume in 2020 in Poland

“…The results of our study confirm how large of an impact COVID-19 had on the joint arthroplasty volume in 2020. The large number of cancelled or postponed surgeries resulted in significant financial losses of medical institutions, changes in clinical practice of orthopaedic surgeons, as well as a profound effect on the physical, psychological and financial status of the patients awaiting the joint replacement [24][25][26][27][28][29]. Furthermore, younger patients with higher pain levels and worse joint function were more eager to proceed with the surgery, despite the pandemic [27,29].…”

“…The large number of cancelled or postponed surgeries resulted in significant financial losses of medical institutions, changes in clinical practice of orthopaedic surgeons, as well as a profound effect on the physical, psychological and financial status of the patients awaiting the joint replacement [24][25][26][27][28][29]. Furthermore, younger patients with higher pain levels and worse joint function were more eager to proceed with the surgery, despite the pandemic [27,29]. Despite the impaired quality of life, most patients awaiting total joint arthroplasty (TJA) understood the need for the surgery delay due to the pandemic and said it was in their best interest [30].…”

Did COVID-19 impact osteoarthritis – clinical perspective?

“…The data suggest an urgent need to increase healthcare resources to accommodate incoming new cases without adding to the backlog [ 14 ]. A prospective qualitative study in Ireland assessed the attitudes, awareness, and behavioral changes in OA patients awaiting total joint arthroplasty during the COVID-19 pandemic [ 15 ]. Sixty-five patients completed a telephone questionnaire within one week in May 2020; 86% felt there was a minimum chance of contracting the COVID-19 infection, and this was noted mainly in participants younger than sixty-five years of age [ 15 ].…”

“…A prospective qualitative study in Ireland assessed the attitudes, awareness, and behavioral changes in OA patients awaiting total joint arthroplasty during the COVID-19 pandemic [ 15 ]. Sixty-five patients completed a telephone questionnaire within one week in May 2020; 86% felt there was a minimum chance of contracting the COVID-19 infection, and this was noted mainly in participants younger than sixty-five years of age [ 15 ]. Patients with a preoperative modified Harris Hip Score below 50 were more interested in proceeding with surgery during the pandemic [ 15 ].…”

Non-medical risk factors associated with postponing elective surgery: a prospective observational study

“…In cancer patients, an increase in mortality has been shown as a consequence of long-term delay of operations [2]. Recently, medical and psychological effects of postponing operations have been described extensively during the Covid-19 pandemic, e. g. an increase in anxiety in cancer patients [3] or an increase in impairment of physical function in patients awaiting to undergo hip arthroplasty [4]. A UK network analysed the psychological and economic burden induced by socalled "winter cancellations" in the NHS.…”