Resuming elective orthopaedic services during the COVID-19 pandemic

Abstract

Aims The aim of this study was to surveil whether the standard operating procedure created for the NHS Golden Jubilee sufficiently managed COVID-19 risk to allow safe resumption of elective orthopaedic surgery. Methods This was a prospective study of all elective orthopaedic patients within an elective unit running a green pathway at a COVID-19 light site. Rates of preoperative and 30-day postoperative COVID-19 symptoms or infection were examined for a period of 40 weeks. The unit resumed elective orthopaedic services on 29 June 2020 at a reduced capacity for a limited number of day-case procedures with strict patient selection criteria, increasing to full service on 29 August 2020 with no patient selection criteria. Results A total of 2,373 cases were planned in the 40-week study period. Surgery was cancelled in 59 cases, six (10.2%) of which were due to having a positive preoperative COVID-19 screening test result. Of the remaining 2,314, 996 (43%) were male and 1,318 (57%) were female. The median age was 67 years (interquartile range 59.2 to 74.6). The median American Society of Anesthesiologists grade was 2. Hip and knee arthroplasties accounted for the majority of the operations (76%). Six patients tested positive for COVID-19 preoperatively (0.25%) and 39 patients were tested for COVID-19 within 30 days after discharge, with only five patients testing positive (0.22%). Conclusion Through strict application of a COVID-19 green pathway, elective orthopaedic surgery could be safely delivered to a large number of patients with no selection criteria. Cite this article: Bone Jt Open 2021;2(11):951–957.

COVID-19 and Hip Osteoarthritis Disability-Linkages and Emerging Practice Implications

“…As per Lauwer et al [17] who discussed recent COVID associated trends, while these accommodations and problems have clearly shifted from dealing with the acute effects of this virus towards the management of its long-term morbidity manifestations, it can be deduced that a fair number of older hip osteoarthritis cases may well be expected to enter surgery, if this is desirable, either with a COVID diagnosis, a deterioration in their pre pandemic symptoms, more fatigue and mental health symptoms, and pain, and may yet acquire this illness on returning home, especially if they are in the older age ranges and have one or more chronic illnesses [20]. Moreover, even if no such illness prevails, it can be hypothesized that the COVID-19 virus or its emerging vaccine resistant novel variants can still contribute to age-related perturbations in those endothelial and adipose tissue elements known to characterize the early aging process, and that underlies osteoarthritis susceptibility, in addition to its well established adverse respiratory effects, even when due precautions are taken [21].…”

No time to waste; the impact of the COVID-19 pandemic on hip, knee, and shoulder arthroplasty surgeries in the Netherlands and Denmark

“… 35 - 37 Furthermore, studies showed that elective surgery can safely be resumed during the pandemic. 38 - 40 Although it is possible that willingness decreased during this time, it is also likely that reluctance decreases and an influx of new patient referrals will increase again when the pandemic eases.…”

Challenges with patient management of osteoarthritis during the COVID-19 pandemic: review

“…Similarly, some countries like England and Scotland implemented strict pathways/zones that a patient may enter based on their designation as green (COVID-light) or red (confirmed COVID). Adherence to these strict guidelines allowed for elective orthopaedic services during the pandemic while avoiding postoperative COVID-related complications 38 . A second group focused on early discharge.…”