COVID-19 disruptions to elective postoperative care did not adversely affect early complications or patient reported outcomes of primary TKA

Abstract

Introduction Elective orthopedic care, including in-person office visits and physical therapy (PT), was halted on March 16, 2020, at a large, urban hospital at the onset of the local COVID-19 surge. Post-discharge care was provided predominantly through a virtual format. The purpose of this study was to assess the impact of postoperative care disruptions on early total knee arthroplasty (TKA) outcomes, specifically 90-day complications, 120-day rate of manipulation under anesthesia (MUA) and 1-year patient-reported outcome measures (PROMs). Materials and methods Institutional records were queried to identify 624 patients who underwent primary, unilateral TKA for osteoarthritis and who were discharged home between 1/1/20 and 3/15/20. These patients were compared to 558 controls discharged between 1/1/19 and 3/15/2019. Cohort demographics and in-hospital characteristics were equivalent apart from inpatient morphine milligram equivalent (MME) consumption. Patient-reported access to PT ( p < 0.001) and post-discharge care ( p < 0.001) were worse among study patients. Study patients were prescribed fewer post-discharge PT sessions (19.8 vs. 23.5; p < 0.001) and utilized telehealth more frequently ( p < 0.001). Mann–Whitney U , T , Fisher’s Exact, and chi-squared tests were used to compare outcomes. Results Ninety-day CMS complications were lower among study patients (3.5% vs. 5.9%; p = 0.05). Rates of MUA were similar between groups. Study patients reported similar PROMs and marginally inferior VR-12 mental and LEAS functional outcomes at 1 year. Conclusion Disruptions to elective orthopedic care in March 2020 seemed to have had no major consequences on clinical outcomes for TKA patients. Our findings question the usefulness of pre-pandemic post-discharge protocols, which may over-emphasize in-person visits and PT.

Does COVID-19 Infection within 1 Week after Total Knee Arthroplasty Affect Patients’ Early Clinical Outcomes? A Matched Case–Control Study

“…Moreover, no study has demonstrated the effect of COVID-19 infection within 1 week after TKA on early clinical outcomes and complications. Recent studies have reported that previous COVID-19 infections do not adversely PROMs or complications of primary TKA [ 10 , 11 ].The findings of the current study are consistent with those of previous studies and indicate no significant difference in PROMs between the two groups, even if infection occurred within 1 week after TKA. Furthermore, although previous studies have shown a higher incidence of postoperative complications after TKA for previous COVID-19 infection [ 29 , 30 ], in our study, no difference was found between the groups in terms of pneumonia and other significant complications.…”

“…However, another study reported that a history of COVID-19 infection does not appear to increase the risk of VTE following primary TKA [ 10 ]. Furthermore, a recent study reported that COVID-19 did not adversely affect early complications or patient-reported outcomes measures (PROMs) after TKA [ 11 ]. However, all these studies were conducted on patients who had COVID-19 infection before TKA; further, the timing of infection before the surgery was not constant [ 8 , 9 , 10 , 11 ].…”

“…Furthermore, a recent study reported that COVID-19 did not adversely affect early complications or patient-reported outcomes measures (PROMs) after TKA [ 11 ]. However, all these studies were conducted on patients who had COVID-19 infection before TKA; further, the timing of infection before the surgery was not constant [ 8 , 9 , 10 , 11 ]. Moreover, the influence of COVID-19 infection on the body may decrease over time after infection [ 12 ].…”

Delay of total joint replacement is associated with a higher 90-day revision rate and increased postoperative complications

“…Given the current evolution of the COVID-19 pandemic, the primary need is to properly allocate resources (staff, beds, ICU beds, economic resources, post-discharge care, etc.) [ 45 ] and contain the pandemic spread. However, given the continuing and recurring constraints, secondarily in the long term, it is also necessary to find strategies and ways to allow elective surgery to avoid the far-reaching consequences that arise from surgical delays.…”

Challenges with patient management of osteoarthritis during the COVID-19 pandemic: review

“…One study saw a significant correlation between inferior clinical outcomes at 6 months and missed physiotherapy 31 . Another study saw that despite decreased care access and post-surgical PT compared with pre-pandemic patients, 1-year clinical outcomes were equivalent 32 . This highlights that there may be an over-emphasis on in-person follow-up and PT for post-arthroplasty patients and requires future exploration in the future.…”