Quantifying the Backlog of Total Hip and Knee Arthroplasty Cases: Predicting the Impact of COVID-19

Abstract

Background Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are two high-volume procedures that were delayed due to COVID-19. Questions/Purposes To help strategize an effective return to elective orthopedic surgery, we aimed to quantify the volume of THA and TKA cases delayed across the USA and estimate the time required to care for these patients when non-urgent surgery resumes. Methods Population-level data was used to estimate monthly THA and TKA procedural volume from 2011 to 2017. Using linear regression, we used this data to project monthly procedural volumes for 2020 to 2023. Nine different permutations were modeled to account for variations in case delay rates (50%, 75%, 100%) and in resumption of non-urgent procedure timing. Two recovery pathways using the highest volume month as a surrogate for maximum operative capacity, and a second using the highest month + 20% were used to simulate a theoretical expansion of current capacity. Results The projected national volume of delayed cases was 155,293 (mid-March through April; 95% CI 142,004 to 168,580), 260,806 (through May; 95% CI 238,658 to 282,952), and 372,706 (through June; 95% CI 341,699 to 403,709). The best- and worst-case scenarios for delayed cases were 77,646 (95% CI 71,002 to 84,290) and 372,706 (95% CI 341,699 to 403,709), respectively. The projected catch-up time varied between 9 and nearly 35 months for the best- and worst-case scenarios. The addition of 20% increased productivity decreased this time to between 3.21 and 11.59 months. Conclusion The COVID-19 pandemic has generated a significant backlog of THA and TKA procedures. Surgeons, administrators, and policymakers should account for these modeled estimates of case volume delays and projected demands. Electronic supplementary material The online version of this article (10.1007/s11420-020-09806-z) contains supplementary material, which is available to authorized users.

Patient Perceptions of COVID-19-Related Surgical Delay: An Analysis of Patients Awaiting Total Hip and Knee Arthroplasty

“…After the COVID-19 pandemic resulted in an abruptly reduced number of THA and TKA procedures being performed in the USA, the number of patients waiting for these procedures is likely higher now than at any other time in modern medicine [40]. The aim of this study was to investigate patient perceptions regarding these mandatory, COVID-19-related surgical delays.…”

“…The current backlog of patients waiting for surgery creates a threat to patient wellbeing [40]. Prior investigations in patients waiting for surgery have reported disease progression, including a decline in both physical function and psychological wellbeing [2, 3, 17, 22].…”

“…Compliance among hip and knee arthroplasty surgeons was high; a survey conducted by the American Association of Hip and Knee Surgeons (AAHKS) found that 92% of members' hospitals had ceased performance of elective surgery [1]. Given the volume of case cancellations and ongoing demand for these procedures [28, 37], there has been a rapid accumulation of patients awaiting surgery [40].…”

The Initial Impact of COVID-19 on Total Hip and Knee Arthroplasty

“…We also found surgical volume decreases in essential orthopaedic surgeries, such as THA for femoral neck fracture, and non-orthopaedic surgeries, such as CABG and major bowel procedures, but none as severe as primary total joint arthroplasty. This led to a significant backlog of arthroplasty procedures that needed to be performed and has had lasting effects on the practice of arthroplasty [ 10 , 11 ]. We did not see a similar dramatic decrease in revision arthroplasty volume.…”

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

“…Assuming 110% of pre-pandemic productivity, it will take around 3 years to catch up with the demand. According to other studies, it is projected that even with 120% pre-COVID productivity, the catch up will take from 1 to 4 years [19,35].…”