Resuming elective hip and knee arthroplasty in the COVID-19 era: a unique insight into patient risk aversion and sentiment

Abstract

Introduction There has been guidance from the government and orthopaedic community on how best to ensure the safety of our patients and colleagues as we recommence elective surgery in the UK. The primary aim was to determine what proportion of patients feel they should proceed with their elective hip and knee arthroplasty surgery during the COVID-19 climate. The secondary aim was to investigate what variables affected this decision. Methods Patient information from a single surgeon's waiting list in a district general hospital were recorded. A standardised telephone discussion was had with all the patients noting the severity of pain and the potential reasons for not wanting to proceed with surgery. Results A total of 70.6% (96/136) of patients wished to proceed with surgery; 29.4% (40/136) did not wish to proceed. The decision to proceed with surgery was not correlated with sex, American Society of Anesthesiologists grade or COVID-19 risk. Those who wished to proceed with surgery had a mean age of 68.5 years while those who did not had a mean age of 72.4 years (P = 0.03). Within the matched subgroups, patients under the age of 70 years were more willing to proceed with primary hip arthroplasty surgery (87.9%) compared with primary knee arthroplasty surgery (57.1%; P = 0.007); 75% of the patients who did not wish to proceed with surgery expressed concerns about perioperative COVID-19 infection. Conclusion There is a significant proportion of arthroplasty patients on waiting lists who would be willing to accept the increased risks associated with COVID-19 to undergo surgery on an urgent basis. The subgroup of younger patients awaiting hip arthroplasty is more willing than those awaiting knee arthroplasty to proceed with surgery.

Reduction in hospital length of stay and increased utilization of telemedicine during the “return-to-normal” period of the COVID-19 pandemic does not adversely influence early clinical outcomes in patients undergoing total hip replacement: a case-control study

“…The waiting lists for elective total hip replacement (THR) soared during this period. Given deterioration in the quality of life and health status of patients with debilitating hip pain from arthritis, many were willing to undergo THR in the early “return-to-normal” period after the peak of the pandemic ( 5 ). Due to the increased demand and the risk of COVID-19 for patients and healthcare workers, early mobilization and discharge protocols were maximized.…”

Did we do it right? The effect of postponing elective orthopedic surgeries due to the pandemic on the quality of life

“…During the pandemic of our age, elective surgeries have been ceased in most countries to reduce hospital admissions and to direct facilities to pandemic patients (6,8,9,(12)(13)(14). In orthopedics, especially patients who are waiting for knee and hip arthroplasties are affected by this situation, and they are forced to live with a very low quality of life, which is described as "worse than death" situation in the literature (7,8).…”

“…On the other hand, it is an inevitable fact that these postponed surgeries reduce the quality of life of patients. Indeed, there are several studies in the literature stating that postponed surgeries reduce the quality of life and patients want to have elective surgery despite the risk of COVID-19 transmission (6)(7)(8)(9).…”

Did COVID-19 impact osteoarthritis – clinical perspective?

“…However, the unchanged incidence of emergency hip surgeries in older women was attributed to intrinsic causes such as osteoporosis [ 2 ▪ ]. A survey conducted in the United Kingdom explored patients’ willingness to proceed with elective hip and knee arthroplasty during the COVID-19 pandemic [ 12 ]. Patients from a single surgeon's waiting list were contacted; the survey showed that 70.6% of patients were willing to proceed with the procedure [ 12 ].…”

“…A survey conducted in the United Kingdom explored patients’ willingness to proceed with elective hip and knee arthroplasty during the COVID-19 pandemic [ 12 ]. Patients from a single surgeon's waiting list were contacted; the survey showed that 70.6% of patients were willing to proceed with the procedure [ 12 ]. It was noted that patients were more willing to accept the increased risk of COVID-19 infection and proceed with elective hip arthroplasty (87.9%) compared with elective knee arthroplasty (57.1%, P = 0.007) [ 12 ].…”