The impact of COVID-19 on the orthopaedic patient in Slovenia: Hip and knee replacement surgery, 90-Day mortality, outpatient visits and waiting times

Abstract

Introduction The purpose of the study was to analyse the impact of the COVID-19 pandemic on the healthcare of the orthopaedic patient, i.e. numbers of hip and knee replacement surgeries, 90-day mortality, waiting times and outpatient clinic visits. Methods The Hip (HR) and Knee Replacement (KR) records from The National Arthroplasty Registry of Slovenia in the pandemic year 2020 were compared to the year 2019. To compare reasons for revision and 90-day mortality the Chi-square test was used. The median values of the number of operations and waiting times were compared with the 95% confidence intervals. The number of outpatient clinic visits was tested with the Wilcoxon Signed Ranked test. Results All operations fell by 19%, from 7825 to 6335. The number of Primary Total HR declined from 3530 to 2792 (21%) and the number of Primary KR from 3191 to 2423 (24%). The number of hip revisions declined by 10% and knee revisions by 25%. We did not find differences in 90-day mortality (p=0.408). Outpatient clinic visits fell from 228682 to 196582 (14%) per year. Waiting times increased by 15% for HR and by 12% for KR. Conclusion There was an inevitable drop in the number of surgeries and outpatient clinic visits in the spring and autumn lockdown. With the reorganisation of the orthopaedic service in Slovenia, the number of KR and HR stayed at a relatively high level despite the pandemic. An epidemiological model and mechanisms for the reduction of waiting times could overcome the impact of the epidemic.

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

“…24 Other countries mentioned major effects of the pandemic on hip and knee arthroplasty procedures, with drops ranging from 20% to 61%. [25][26][27][28] Similar to our results, these studies also observed the most significant decrease during April and May of 2020. Furthermore, a survey administered within the European Hip Society (EHS) and Knee Associates (EKA) showed that primary total joint replacements (TJRs), alongside with aseptic revisions, were impacted most, while septic revisions and periprosthetic fractures were still performed.…”

“…The backlog, caused by postponing arthroplasty surgery, occurred in many countries. 26 Oussedik et al 30 showed that elective orthopaedic waiting lists in England were approximately three times the pre-COVID-19 average in November 2020. Similarly to other studies, we estimate that the effect of the pandemic is long lasting, and will be cumulative if no extra surgical capacity can be created.…”