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The impact of vaccination and new SARS-CoV-2 variants on peri-operative outcomes is unclear. We aimed to update previously published consensus recommendations on timing of elective surgery after SARS-CoV-2 infection to assist policymakers, administrative staff, clinicians and patients. The guidance remains that patients should avoid elective surgery within 7 weeks of infection, unless the benefits of doing so exceed the risk of waiting. We recommend individualised multidisciplinary risk assessment for patients requiring elective surgery within 7 weeks of SARS-CoV-2 infection. This should include baseline mortality risk calculation and assessment of risk modifiers (patient factors; SARS-CoV-2 infection; surgical factors). Asymptomatic SARS-CoV-2 infection with previous variants increased peri-operative mortality risk three-fold throughout the 6 weeks after infection, and assumptions that asymptomatic or mildly symptomatic omicron SARS-CoV-2 infection does not add risk are currently unfounded. Patients with persistent symptoms and those with moderate-to-severe COVID-19 may require a longer delay than 7 weeks. Elective surgery should not take place within 10 days of diagnosis of SARS-CoV-2 infection, predominantly because the patient may be infectious, which is a risk to surgical pathways, staff and other patients. We now emphasise that timing of surgery should include the assessment of baseline and increased risk, optimising vaccination and functional status, and shared decision-making. While these recommendations focus on the omicron variant and current evidence, the principles may also be of relevance to future variants. As further data emerge, these recommendations may be revised.

We describe the clinical and radiological outcome of 100 consecutive total hip replacements in 86 patients using the JRI Furlong hydroxyapatite-coated femoral component. The follow-up was 100% at a mean of ten years (9.0 to 12.0). All 54 living patients (62 hips) were examined annually. Their mean Merle d'Aubigné score was 5.8/5.6/4.6. A total of 32 patients had died. Their notes at the last annual assessment recorded a similar outcome to that of the living patients. Radiographs showed no radiolucent lines around any femoral component and there were no signs of impending failure. One patient required excision arthroplasty, but the femoral component had been bonded satisfactorily. There have been no other revisions of femoral components. Our findings suggest that the hydroxyapatite coating gives a satisfactory prosthesis-bone interface which is preferable to any other system.

There is a paucity of long-term follow-up studies of total hip replacement (THR).1 We describe the ten-year results of a prosthesis with a hydroxyapatite (HA)-coated femoral stem and a collar (Fig. 1). Patients and MethodsBetween February 1986 and February 1989, we performed 100 consecutive THRs in 86 patients using the JRI Furlong HA-coated femoral component (JRI Instrumentation Ltd, London, UK). A 32 mm ceramic head was used and the ultra-high-density polyethylene cup was cemented. The age range of patients was 45 to 94 years with most aged between 65 and 79 years. The mean follow-up was for ten years (9 to 12). The operation was carried out by one of two surgeons (JANS or trainee under supervision) using a Watson-Jones approach. Bilateral procedures were performed in sequence under the same anaesthetic. Immediate full weight-bearing was encouraged after surgery and patients were discharged as soon as possible. All patients were then seen at six weeks, three and six months, one year and then annually for a clinical and radiological review.At each review we noted documented complications, the requirement for revision and the visual analogue scale for pain, assessed the Merle d'Aubigné and Postel (MDP) score for pain, range of movement and function, 2 and obtained radiographs of the pelvis and hips. On the visual Fig. 1 Photograph of the prosthesis. The femoral stem is fully coated with HA.

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