Total Joint Arthroplasty During the COVID-19 Pandemic: A Scoping Review with Implications for Future Practice

Chen, Aaron Z.; Shen, Tony S.; Bovonratwet, Patawut; Pain, Kevin; Murphy, Alexander I.; Su, Edwin P.

doi:10.1016/j.artd.2020.12.028

Cited by 25 publications

(20 citation statements)

References 57 publications

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“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Gordon

Magruder

et al. 2022

Arthroplasty

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Introduction As a result of the SARS-CoV-2 (COVID-19) pandemic in 2020, elective surgeries, including total joint arthroplasty (TJA), were suspended nationwide. Concurrent removal of total hip arthroplasty (THA) from the Medicare inpatient-only list posed challenges to the delivery of quality patient care with low payor cost. Therefore, the objective of this study was to compare temporal trends in patient demographics, case volumes, length of stay, and complications following elective THA in the years 2019 to 2020 in the United States. Methods The 2019 to 2020 ACS-NSQIP database was queried for elective THA patients. Patients Pre-COVID (2019 and 2020Q1) were compared with post-COVID (2020Q2-Q4). THA utilization, demographics, 30-day complications, and length of stay (LOS) were compared between years. Linear regression evaluated changes in case volumes over time with significance threshold of P < 0.05. Results A total of 77,797 patients underwent elective THA in 2019 (n = 43,667) and 2020 (n = 34,130), resulting in a 24.5% decline. Outpatient THA increased in 2020 (35.6%) vs. 2019 (5.7%) (P < 0.001). There was no significant difference in the volume of cases in 2019Q1 through 2019Q4 (P = 0.984). Elective THA volumes declined by 68.8% in 2020Q2, returned to pre-pandemic baseline in 2020Q3, before leveling off at 81.5% of baseline in Q4. Average LOS was significantly shorter in 2020 (1.55 days) vs. 2019 (1.78 days) (P < 0.001) and the proportion of same day discharge (SDD) increased quarterly from 2019 to 2020. There was no significant difference in the total complication rates in 2019 (6.6%) vs. 2020 (6.6%) (P = 0.831). Discussion Elective THA precipitously declined during the second quarter of 2020. The combined effect of policy changes and the COVID-19 pandemic resulted in a seven-fold increase in the number of surgeries performed in the outpatient setting in 2020. Rates of SDD doubled over the study period, despite no change in complication rates.

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Section: Introductionmentioning

confidence: 99%

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

Gordon

Magruder

et al. 2022

Arthroplasty

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“…The authors of the study highlighted the importance of outpatient surgery, notably to minimize costs while improving the value of care. 12 The outpatient total joint replacement research scene is primarily dominated by newer publications from 2016 onward, but a dichotomy of "newer" and "older" still exists, given that the most cited paper in the field is one of the oldest, from 2005. Our study elucidates this rather clearly.…”

Section: Discussionmentioning

confidence: 99%

The Most Influential Publications in Outpatient Total Joint Arthroplasty

et al. 2022

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Background Total joint replacements are some of the most common procedures performed by surgeons. There has been a recent increase to transition these procedures to the outpatient setting. Objective Our study seeks to identify the most influential publications, in terms of total citations, regarding outpatient total hip and knee replacement surgeries. Methods The database used to collect the data for this analysis was Clarivate Analytics Web of Science. The search query selected and used to collect data was: “outpatient or ambulatory,” with a “Title” filter AND “total joint replacement” AND “total joint arthroplast*” with “Topic” filters. The papers returned were then sorted by total number of citations and exported to Google Sheets for further analysis. Results The most cited publication was “Outpatient total knee arthroplasty with a minimally invasive technique,” by Berger et al.. This was the oldest publication analyzed (2005), the most recent publication being published in 2020. The publications analyzed were cited a total number of 1,774 times and averaged 35.5 citations per year. The Journal with the most attributable publications was The Journal of Arthroplasty. Conclusion This study provides a measure of the most cited articles on outpatient arthroplasty. Most literature on the topic were categorized as Clinical Science and Outcomes (50%), comprised level of evidence III (28%), were published in the Journal of Arthroplasty (54%) and came out of the United States (76%). Knowledge of these most influential articles allows for a foundation of understanding on a rapidly growing area of arthroplasty among clinicians.

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“…The latter is particularly relevant due to the lower costs associated with home-based programs. Furthermore, the COVID-19 pandemic has highlighted the need for remote models of care [104,105]. Using digital tools to deliver TKR care remotely offers multiple potential benefits, such as improved service efficiency and greater patient engagement [84,104].…”

Section: Implications For Clinical Practice and Future Researchmentioning

confidence: 99%

Content and delivery of pre-operative interventions for patients undergoing total knee replacement: a rapid review

Anderson

Drew²,

Antcliff³

et al. 2022

Syst Rev

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Background Total knee replacement (TKR) is a common operation typically performed for end-stage knee osteoarthritis. Patients awaiting TKR often have poor health-related quality of life. Approximately 20% of patients experience persistent pain post-TKR. Pre-operative TKR interventions could improve pre- and post-operative outcomes, but future research is required to inform their design. This review aimed to identify and synthesize recent literature on the content and delivery of pre-operative TKR interventions to help guide future research and clinical practice. Methods This rapid review included randomized trials of pre-operative TKR interventions (“outcomes studies”) and primary studies exploring patients’ and/or health professionals’ views of pre-operative TKR interventions (“views studies”). Medline, Embase, PsycINFO, CINAHL and the Cochrane Central Register of Controlled Trials were searched for English language studies published between January 2009 and December 2020. Eligible studies’ reference lists were screened. Studies were appraised using the Mixed Methods Appraisal Tool. The findings were narratively synthesized using a convergent segregated approach. Results From 3263 records identified, 52 studies were included (29 outcomes studies, 21 views studies, two outcomes/views studies). The studies’ methodological quality varied but was generally highest in qualitative studies. The outcomes studies investigated education (n=5), exercise (n=20), psychological (n=2), lifestyle (n=1), and/or other interventions (n=5). The views studies addressed education (n=20), exercise (n=3), psychological (n=1), lifestyle (n=4), and/or other interventions (n=1). Only three outcomes studies (two randomized controlled trials (RCTs) and a pilot study) compared the effectiveness of intervention components/delivery approaches. The two RCTs’ results suggest that pre-operative TKR exercise interventions are equally effective regardless of whether they include strength or strength plus balance training and whether they are hospital- or home-based. Personal tailoring and using more than one delivery format were associated with improved outcomes and/or perceived as beneficial for multiple intervention types. Conclusions Definitive evidence on the optimal design of pre-operative TKR interventions is lacking. Personal tailoring and employing multiple delivery formats appear to be valuable design elements. Preliminary evidence suggests that including balance training and hospital versus home delivery may not be critical design elements for pre-operative TKR exercise interventions. Systematic review registration PROSPERO CRD42019143248 Funder National Institute for Health and Care Research (ICA-CDRF-2018-04-ST2-006).

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Total Joint Arthroplasty During the COVID-19 Pandemic: A Scoping Review with Implications for Future Practice

Cited by 25 publications

References 57 publications

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

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

The Most Influential Publications in Outpatient Total Joint Arthroplasty

Content and delivery of pre-operative interventions for patients undergoing total knee replacement: a rapid review

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