Pain and function deteriorate in patients awaiting total joint arthroplasty that has been postponed due to the COVID-19 pandemic

Abstract

BACKGROUND Elective total joint arthroplasty (TJA) procedures have been postponed as part of the coronavirus disease 2019 (COVID-19) response to avert healthcare system collapse. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures comprise the highest volume of elective procedures performed at health care facilities worldwide. AIM To determine the demand for TJA despite the pandemic and the impact of surgery postponement on physical and mental health. METHODS We conducted a prospective cross-sectional telephonic interview-based study on patients awaiting THA and TKA at an academic institution in South Africa. The questionnaire consisted of four sections. The first section recorded baseline demographic data and medical co-morbidities, the length of time spent awaiting TJA, and the patients’ desire to undergo elective surgery despite the COVID-19 pandemic. Section 2 and Section 3 assessed the patients’ current physical and mental health, respectively, as a consequence of deferred surgical intervention. The last section established the patients’ perception of the healthcare system’s response to the COVID-19 pandemic and necessity to postpone elective surgery. Patients received counseling and education on the current state of surgery during the COVID-19 pandemic and associated risks. Thereafter, patients were once again asked about their desire to undergo TJA during the COVID-19 pandemic. RESULTS We included 185 patients (65.95% female; mean age: 50.28 years) awaiting TJA for a mean of 26.42 ± 30.1 mo. Overall, 88.65% of patients wanted TJA despite the COVID-19 pandemic. Patients awaiting TJA for 1-3 years were 3.3-fold more likely to want surgery than those waiting < 1 year ( P < 0.000). Patients with comorbidities were 8.4-fold less likely to want TJA than those with no comorbidities ( P = 0.013). After receiving education, the patients wanting TJA decreased to 54.05%. Patients who changed their opinion after education had less insight on the increased morbidity ( P = 0.046) and mortality ( P = 0.001) associated with COVID-19. Despite awaiting TJA for shorter period (24.7 ± 20.38 mo), patients who continued to demand TJA had greater pain ( P < 0.000) and decreased function ( P = 0.043) since TJA postponement. CONCLUSION There is deterioration in health for patients, who have had elective procedures postponed during the COVID-19 pandemic. Waiting lists should be prioritized for urgency with the re-initiation of elective surgery.

Questionnaire survey about the effects of new lifestyles during the pandemic of COVID-19 on upper limb diseases

“…There have been detrimental changes in health in patients who have postponed elective procedures during the COVID-19 pandemic. [ 12 ].…”

Universal COVID-19 pre-procedural swabs in children in a developing country: A comparison of findings over two transmission waves

“… 10 With the practice of pre-procedural swabbing, healthcare workers in the hospital can be protected from the risk of COVID-19 infection, especially from asymptomatic patients. 11 …”

The effect of the COVID-19 pandemic on revision total hip and knee arthroplasty at a large academic hospital network

“…It has been shown that patients who delay their primary TKA and THA have health deterioration due to increased pain and decreased function. 8 It would be interesting to determine if the same holds true for revision TJA patients that delay their care. Additional long-term studies comparing re-revision TJA rates prior to the pandemic and after the shutdown time period would also be of interest.…”