Lessons learnt from the impact of COVID-19 on arthroplasty services in Hong Kong: how to prepare for the next pandemic?

Abstract

Background Arthroplasty services worldwide have been significantly disrupted by the pandemic of coronavirus disease 2019 (COVID-19). This retrospective comparative study aimed to characterize its impact on arthroplasty services in Hong Kong. Methods From January 1 to June 30, 2020, the patients of “COVID-19 cohort” underwent elective total hip or knee replacement in Hong Kong public hospitals. The cohort was compared to the “control cohort” during the same period in 2019. Data analysis was performed to compare the two cohorts’ numbers of operations, hospital admission, orthopaedic clinic attendances, and waiting time. Results A total of 33,111 patient episodes were analyzed. During the study period, the elective arthroplasty operations and hospitalizations decreased by 53 and 54%, respectively (P < 0.05). Reductions were most drastic from February to April, with surgical volume declining by 86% (P < 0.05). The primary arthroplasty operations decreased by 91% (P < 0.05), while the revision operations remained similar. Nevertheless, 14 public hospitals continued performing elective arthroplasty for patients with semi-urgent indications, including infection, progressive bone loss, prosthesis loosening, dislocation or mechanical failure of arthroplasty, and tumor. At the institution with the highest arthroplasty surgical volume, infection (28%) was the primary reason for surgery, followed by prosthesis loosening (22%) and progressive bone loss (17%). The orthopaedic clinic attendances also decreased by 20% (P < 0.05). Increases were observed in waiting time and the total number of patients on the waiting list for elective arthroplasty. Conclusions Despite the challenges, public hospitals in Hong Kong managed to continue providing elective arthroplasty services for high-priority patients. Arthroplasty prioritization, infection control measures, and post-pandemic service planning can enhance hospital preparedness to mitigate the impact of current and future pandemics.

Feasible non-surgical options for management of knee osteoarthritis during the COVID-19 pandemic and beyond

“…A recent analysis of COVID-19 effects on arthroplasty Hong Kong Med J 2024;30:56-61 https://doi.org/10.12809/hkmj2210209 services in Hong Kong showed large (>50%) decreases in elective arthroplasties and surgical volume from January to June 2020. 4 Although the rate of revision operations remained similar during this period, the number of primary arthroplasty operations decreased by 91%, emphasising the importance of effective non-surgical treatment options for knee OA. 4 The multifactorial aetiology and slow progression of knee OA enable implementation of diverse therapeutic regimens.…”

“…4 Although the rate of revision operations remained similar during this period, the number of primary arthroplasty operations decreased by 91%, emphasising the importance of effective non-surgical treatment options for knee OA. 4 The multifactorial aetiology and slow progression of knee OA enable implementation of diverse therapeutic regimens. Non-surgical treatments can be broadly divided into non-pharmacological (preferred) and pharmacological options (Fig).…”

Effect of COVID-19 on the Burden and Profile of Orthopaedic Patients Admitted Post-Resumption of Routine Services in a Tertiary Care Hospital in Delhi

“…In a study done in another tertiary care centre in a different region of the same country, it was found that there was a reduction of 62.6% in the number of orthopaedic-related trauma cases during the lockdown period [ 12 ]. According to a study done in Hong Kong, there was a 53% reduction in elective joint replacement procedures from January to June 2020 [ 13 ]. The number of orthopaedic patients waiting for surgery has dramatically increased as a result of elective surgery cancellations and postponements.…”

Milder impact of the COVID-19 pandemic on the practice of orthopaedic surgery in Greece and Cyprus than other European countries

“…In a survey, the American Association of Hip and Knee Orthopedic Surgeons (AAHKS) estimates that hospitals stopped 92% of all elective surgeries [ 3 ]. However, a study from Hong Kong reports, for the period January to June 2020, a 53% reduction in elective joint replacement operations [ 17 ].…”