Purpose Health care systems in most European countries were temporarily restructured to provide as much capacity as possible for the treatment of coronavirus disease 2019 (COVID-19) patients. Subsequently, all elective surgeries had to be cancelled and postponed for months. The aim of the present study was to assess the pretreatment health status before and after COVID-19-related cancellation and the psychosocial distress caused by the cancellation. Methods For this study, a questionnaire was developed collecting sociodemographic data and information on health status before and after the cancellation. To assess psychosocial distress, the validated depression module of the Patient Health Questionnaire (PHQ-9), was implemented. PHQ-9-Scores of 10 and above were considered to indicate moderate or severe depressive symptoms. In total, 119 patients whose elective orthopaedic surgery was postponed due to the COVID-19 pandemic were surveyed once at least 8 weeks after the cancellation. Results Seventy-seven patients (65%; 34 female, 43 male) completed the questionnaire and were included. The predominant procedures were total knee arthroplasty (TKA), hip arthroscopy and foot and ankle surgery. The mean pain level significantly increased from 5.5 ± 2.2 at the time of the initially scheduled surgery to 6.2 ± 2.5 at the time of the survey (p < 0.0001). The pain level before cancellation of the surgery was significantly higher in female patients (p = 0.029). An increased analgetic consumption was identified in 46% of all patients. A mean PHQ-9 score of 6.1 ± 4.9 was found after cancellation. PHQ-9 scores of 10 or above were found in 14% of patients, and 8% exhibited scores of 15 points or above. Significantly higher PHQ-9 scores were seen in female patients (p = 0.046). No significant differences in PHQ-9 scores were found among age groups, procedures or reasons for cancellation. Conclusion Cancellation of elective orthopaedic surgery resulted in pain levels that were significantly higher than when the surgery was scheduled, leading to increased analgesic use. Additionally, significant psychosocial distress due to the cancellation was identified in some patients, particularly middle-aged women. Despite these results, confidence in the national health care system and in the treating orthopaedic surgeons was not affected. Level of evidence Level III.

Background/Aim: Increasing economic pressure in modern healthcare necessitates an increase in efficiency in total knee arthroplasty (TKA) while maintaining highquality outcomes. Removal of debris using pulsatile lavage (PL) during cement polymerization may considerably reduce the operative duration. However, water can penetrate the interface, resulting in impaired implant fixation. The aim of the present study was to investigate the impact of early-onset PL during bone cement polymerization on implant fixation and operative duration. Materials and Methods: Cemented implantation of tibial trays was performed in 20 fresh-frozen human tibiae from 10 donors in a matched-pair study design in two groups: 1) PL during cement polymerization; and 2) PL after completion of the polymerization process. The cement penetration depth was analysed by computed tomography (CT), and the pull-out force was measured to evaluate primary implant fixation. The duration of the procedure was recorded for both groups. Results: Comparable pull-out forces were observed in the experimental (2,213 N) and control groups (2,350 N; p=0.68). The mean depth of cement penetration was similar in both groups. PL during cement polymerization could decrease the operative duration by 10 min. Conclusion: The application of PL during cement polymerization could significantly reduce operative duration and had no adverse effect on the mechanical fixation of the tibial component.Osteoarthritis of the knee is one of the most common joint disorders in adults, and total knee arthroplasty (TKA) is the only causal therapy for end-stage osteoarthritis. Despite already high numbers of primary TKA procedures, a further increase is expected due to demographic development in modern industrialized countries (1). TKA is thus a highly effective routine procedure with high patient satisfaction rates and a good implant survival rate of more than 90% after 10-15 years (2).However, despite good to excellent overall survival rates, early aseptic loosening remains one of the leading causes for revision surgery (3). In this context, there has been an increased interest in cementless TKA in recent years, particularly for younger and more active patients (4, 5). However, cemented fixation is still considered the gold standard in TKA (4). Thus, optimization of the cementation technique to increase cement penetration depth is a decisive factor for primary stability (6). In this context, a cement penetration depth of 3-5 mm is known to reduce micromotion at the bone-cement interface, potentially improving implant survival (7-9).The necessity of a thorough cementation and implantation technique stands opposed to the continuously increasing cost pressure and demand for surgical procedures of shorter durations in modern healthcare systems. Regarding TKA, pulsatile lavage (PL) should be used not only for the preparation of the bone stock prior to implantation but also for the removal of bone and cement debris following the implantation process to avoid increased wear rates (10-12). The ...