Impact of COVID-19 on Orthopaedic Care and Practice: A Rapid Review

Abstract

Introduction The COVID-19 pandemic has led to a large body of literature regarding the impact of COVID-19 on orthopaedic care and practice. This rapid review aims to synthesize this published literature to give the orthopaedic fraternity an overview about the best practices that need to be followed during this period. Methodology A rapid review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement for rapid reviews on the impact of COVID-19 on orthopaedic care and practice. A Pubmed search was done to identify all literature related to the impact of COVID-19 on orthopaedic care and practice, published between December 2019 and October 2020 using a predefined search strategy. The final review included 375 peer-reviewed articles addressing the objectives. Results The majority of articles were expert opinions (37.1%) and narrative reviews (13.1%). There were 17.3% retrospective studies and 2.1% prospective studies with only one randomized control trial and ten systematic reviews. 83.8% of articles had levels of evidence IV and V, 79.5% of the articles were published in core-orthopaedic journals. Maximum publications were from the United States of America (31.7%), followed by India (11.5%). European countries together contributed to 32.0% of all publications. Conclusion COVID-19 has had a significant impact on all aspects of orthopaedic care and practice. The pandemic has affected outpatient clinics, emergency and elective surgery, rehabilitation, resident training, personnel management, use of personal protective equipment, telemedicine and all sub-specialities of orthopaedics. Orthopaedic practice will require the incorporation of new technologies, restructuring of health systems and reorganizing of training programs for optimal patient care. There would also be a need for frequent review of emerging literature to provide evidence-based guidelines to the orthopaedic fraternity which will not only help in mitigation of transmission of disease but also ensure continuity of optimum patient care.

Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review

“…Fifty-nine articles met the inclusion criteria and were considered for the analysis. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 The excluded thirty-four papers were editorials, letters, duplicate entries, and articles with no discussion on telemedicine even in the full text ( Figure 1 ). The monthly contributions trend of the orthopaedic telemedicine-related articles is shown in Figure 2 .…”

“…These review articles supported telemedicine as an alternative mode of patient care to physical outpatient visits. 34 , 35 , 36 , 37 , 38 , 39 , 40 Most review articles critically analysed the available evidence to point out the limitations and ways to improve telemedicine. Loeb et al.…”

Outpatient and Home-Based Treatment: Effective Settings for Hip Fracture Rehabilitation in Elderly Patients

“…The COVID-19 pandemic brought even more pressure to resource management inside and outside the hospital. For many orthopedic services, the local contingency plan meant a reduction on the number of beds and lengths of stay and cancellation of elective surgery [ 38 ]. Ultimately, these measures led to early clinical discharges.…”

“…There was a reduction in the number of treated patients in both inpatient and outpatient facilities due to COVID-19 infection prevention strategies. Tele-rehabilitation and home-based rehabilitation programs have been developed to ensure continuity of care, ensuring the safety of patients and therapists [ 38 ]. Considering this pandemic reality, it is essential to study the therapeutic effectiveness of hip fracture rehabilitation programs in different modalities and settings.…”

Is performing joint arthroplasty surgery during the COVID-19 pandemic safe?: A retrospective, cohort analysis from a tertiary centre in NCR, Delhi, India

“…9 Most of the government tertiary care centres and private hospitals were converted to either partial or full COVID-19 care facilities to deal with the public health emergency. 10,11 Trauma, emergency and urgent orthopaedic care were reorganized following the publication of Indian Orthopedic Association and British Orthopedic Association guidelines. 12 Access to pain relieving joint replacement surgery was restricted due to infection prevention strategies such as national lockdown, quarantine, 'self-isolation' and lack of availability of hospital services.…”