Patient Perspectives on the Cancellation of Elective Primary Hip and Knee Arthroplasty During the COVID-19 Pandemic

Abstract

Introduction: The coronavirus disease 2019 (COVID-19) pandemic resulted in the unprecedented widespread cancellation of scheduled elective primary total joint arthroplasty (TJA) in the United States. The impact of postponing scheduled total hip arthroplasty and total knee arthroplasty procedures on patients has not been well studied and may have physical, emotional, and financial consequences. Methods: All patients whose elective primary TJA procedures at a tertiary academic medical center were postponed because of COVID-19 were surveyed. Seventy-four patients agreed to answer 13 questions concerning the physical, mental, and financial impact of surgery cancellation. Statistical analysis, including Pearson correlation coefficients, cross-tabulation analysis, and chi squares, was performed. Results: 13.5% of patients strongly disagreed with the use of “elective” to describe their cancelled TJA surgery and 25.7% of patients reported substantial physical and/or mental deterioration due to postponement. Younger individuals experienced greater change in their symptoms (P = 0.034), anxiety about their pain (P = 0.010), and frustration/anger (P = 0.043). Poor quality of life, mood, and lower HOOS/KOOS Jr interval scores were correlated with greater financial strain, disagreement with the postponement, and disagreement with the use of “elective” to describe surgery. Disagreement with the use of “elective” to describe surgery was associated with greater financial strain (P = 0.013) and disagreement with the decision to postpone surgery (P = 0.008). In addition, greater financial strain was associated with disagreement with postponement (P = 0.014). Conclusion: The cancellation of elective TJA during the COVID-19 pandemic had a variety of consequences for patients. One in four patients reported experiencing substantial physical and/or emotional deterioration. Associations of poor quality of life and mood with greater financial strain and disagreement with the term “elective” were seen. These results help quantify the deleterious effects of cancelling elective surgery and identify at-risk patients should another postponement of surgery occur. Level of Evidence: Level II—Prospective cohort study

The combined effect of policy changes and the covid-19 pandemic on the same day discharge and complications following total hip arthroplasty: a nationwide analysis

“…Despite these predictions, we did not find any appreciable difference in annual cohorts with respect to age, BMI, and comorbidity burden. Groups have queried patients about their perceptions and feelings about delaying total joint arthroplasties during the pandemic [ 7 , 8 , 10 , 13 ]. Patients have generally felt an increase in anxiety and decline in quality of life [ 5 ].…”

“…Subsequently, the Surgeon General and the Centers for Medicare & Medicaid Services (CMS) declared the cancellation of all elective surgery in the United States in March 2020 [2]. The ramifications of cancelling elective joint arthroplasty have been felt by both patients and orthopedic joint replacement surgeons in the United States [4][5][6][7][8][9][10][11][12][13]. From a surgeon's perspective, the projected backlog of cases was estimated to take between 9 to 35 months to recover [14].…”

An Investigation for Future Practice of Elective Hip and Knee Arthroplasties during COVID-19 in Romania

“…Severe reduction in the number of surgeries due to the pandemic has had unpleasant consequences for patients, causing significant psychosocial distress [ 6 ] and deterioration in the health of patients whose elective procedures were delayed [ 7 ]. One quarter of patients reported experiencing significant physical and emotional impairments [ 8 ]. Patients suffering from hip and knee arthritis pain have continued to struggle with end-stage pain and suffer from anxiety related to the coronavirus disease.…”

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

“…Furthermore, there is research showing that end-stage osteoarthritis causes a higher postoperative need for opioid analgesia and results in a worse outcome in terms of revisions and readmission rates after TJA [ 43 ]. In particular, even psychosocial consequences are to be expected in this context [ 44 ].…”