Prioritising of hip and knee arthroplasty procedures during the COVID-19 pandemic: the European Hip Society and the European Knee Associates Survey of Members

Abstract

Purpose During the COVID-19 pandemic there has been a massive reduction of arthroplasty services due to reallocation of hospital resources. The unique challenge for clinicians has been to define which arthroplasty patients most urgently require surgery. The present study aimed to investigate priority arthroplasty procedures during the pandemic and in the reinstatement period from the surgeon's perspective. Material and methods An online survey was conducted among members of the European Hip Society (EHS), European Knee Associates (EKA) and other invited orthopaedic arthroplasty surgeons (experts) from across the world. The survey consisted of 17 different arthroplasty procedures/indications of which participants were asked to choose and rank the most important 10. Results Four hundred and thirty-nine arthroplasty surgeons from 44 countries responded. The EHS and EKA had a 43% response rate of members. In weighted average points, the majority of respondents (67.5 points) ranked 'acute fractures requiring arthroplasty (Periprosthetic fractures, THA/hemi-arthroplasty for femoral neck fractures)' as priority indication number one, followed by 'first-stage explantations for acute PJI (periprosthetic joint infection)' in second place and priority indication (45.9 points) three as 'one-stage revision for acute PJI' (39.7 points). Conclusions There was agreement that femoral neck fractures, periprosthetic fractures, and acute infections should be prioritised and cannot be postponed in the setting of the COVID-19 pandemic. As arthroplasty procedures are being resumed in most countries now, there has also been a relaxation of lockdown rules in most countries, which might cause a so-called second wave of the pandemic. Therefore, the results of the current study present a proposal by experts as to which operations should be prioritised in the setting of a second wave of the pandemic.

The Oxford Knee Score is a reliable predictor of patients in a health state worse than death and awaiting total knee arthroplasty

“…Therefore, the OKS seems to be more inclusive than exclusive when identifying those who may benefit from a TKA. Not all patients on a waiting list for a TKA are, however, equal and prioritizing according to pain severity and effects on socioeconomic consequences is difficult [ 8 , 10 , 28 ]. Rationing of TKA is inevitable when there are limited resources and demand exceeds capacity [ 12 ].…”

A seven week observational analysis of clinical activities in a North Italian orthopaedic hospital during the second wave of SARS-CoV-2 pandemic: far from usual volumes, but different from the first wave

“…2019). After the first pandemic wave, a slow progressive return towards usual activities occurred, according to international guidelines that acknowledged the reinstating elective orthopaedic surgery [ 6 ] with a huge attention on well-being and safety of patients [ 7 ] according to stringent protocols that contemplate the SARS-CoV-2 screening for all the patients [ 8 ] and the prioritisation of the patients according to the intervention needed [ 9 ]. The advent of a second wave of infections has brought back to light criticalities similar to those emerged during the first part of the year although with some peculiarities.…”

Personal protection equipment for orthopaedic and trauma surgery during the COVID-19 pandemic: The results of an EFORT survey initiative

“…A year and a half following the initial pandemic shock, containment measures such as lockdowns and quarantines were gradually removed and the medical community has started to reorganise medical services at various levels keeping in mind the possibility of future waves of the pandemic, perhaps caused by variants of COVID-19. Orthopaedic surgery has been progressively reestablished at various rates depending on country-specific issues ( 3 , 4 ). Orthopaedic surgery involves several aerosol procedures with the use of high-speed saws, power drills, pulsed lavage, suction and the use of electrocautery ( 5 , 8 , 9 , 19 , 20 , 21 ).…”

“…In March 2020, the World Health Organization (WHO) declared a global pandemic which dramatically changed the priorities and activities of public and health systems ( 2 ). For a considerable period of time, elective surgery was halted and only emergency procedures were carried out depending on country-specific issues ( 3 , 4 , 5 ). The rapid global spread of the virus and the lack of specific treatments led to an increased rate of infections among the general public and health care workers (HCW), and measures of social distancing for the public and the use of personal protection equipment (PPE) for both the public and HCW were enforced.…”