Elective Inpatient Total Joint Arthroplasty Case Volume in the United States in 2020

Abstract

Background: Despite known surgical volume reductions in 2020 during the height of the COVID-19 pandemic, no study has fully quantified the impact of the pandemic on the number of elective inpatient total hip (THA) and total knee arthroplasty (TKA) cases. The purpose of the present study was to analyze THA and TKA case volumes in the United States during the COVID-19 pandemic. Methods: The Premier Healthcare Database was utilized to identify adults undergoing primary elective THA or TKA from January 2017 to December 2020. The National Inpatient Sample was cross-referenced to provide nationwide representative sampling weights. Patients undergoing revision total joint arthroplasty (TJA) or non-elective surgery were excluded. Two quantitative models were created from both databases to estimate TJA case volume in 2020. Descriptive statistics were utilized to report monthly changes in elective TJA utilization throughout 2020. Univariate analyses were performed to compare differences between subgroups. Results: From 2017 to 2019, it was estimated that 1,006,000 elective inpatient TJAs (64.2% TKA and 35.8% THA) were performed annually. In 2020, an estimated 526,000 to 538,000 cases (62.0% TKA and 38.0% THA) were performed, representing a 46.5% to 47.7% decrease in nationwide volume from the prior 3-year average. Moreover, the elective TJA case volume for April 2020 was 1.9% of the average for that month from 2017 through 2019. Subsequently, case volumes for May and June increased compared with the volumes for those months from 2017 through 2019. There was then a decrease in cases for July, corresponding with the "second wave" of COVID-19, followed by an additional steady monthly decline through December, corresponding with the "third wave." Finally, the elective TJA cases for December 2020 represented only 41.0% of the average case volume for that month from 2017 through 2019. continuedDisclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G959).

The effects of the COVID-19 pandemic on elective unicompartmental knee arthroplasty in the USA: further evidence that outpatient arthroplasty is safe and effective

“…In this study, 82% of AAHKS members reported a dramatic reduction in performing inpatient arthroplasty in late March 2020; this rate peaked in early April at 92%, but dropped to a 23% by mid-June 2020 [ 11 ]. It is not surprising that our findings in UKA mirrored that of other arthroplasty procedures [ 19 ].…”

The Effect of COVID-19 on Spine Surgery

“… 15 Heckmann et al used a national inpatient database to assess trends in total hip and knee arthroplasty and found that volume decreased in March and April of 2020 and never increased to pre-pandemic levels throughout the entirety of 2020. 16 …”

The Impact of the COVID-19 Pandemic on the Practice of Hip and Knee Arthroplasty

“…Bedard et al estimated that approximately 30,000 primary and 3,000 revision hip and knee procedures would be cancelled each while restrictions were in place 7 . These cancellations resulted in the overall TJA annual case volume being reduced by nearly 50% in 2020 4 . As a result of elective surgery cancellations, surgeon and hospital revenue for arthroplasty declined by 85% to 90% 6 .…”