Prospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Mar 18, 2021; 12(3): 152-168
Published online Mar 18, 2021. doi: 10.5312/wjo.v12.i3.152
Pain and function deteriorate in patients awaiting total joint arthroplasty that has been postponed due to the COVID-19 pandemic
Jurek Rafal Tomasz Pietrzak, Zia Maharaj, Magdalena Erasmus, Nkhodiseni Sikhauli, Josip Nenad Cakic, Lipalo Mokete
Jurek Rafal Tomasz Pietrzak, Department of Orthopaedics, University of the Witwatersrand, Johannesburg 2193, Gauteng, South Africa
Zia Maharaj, Magdalena Erasmus, Nkhodiseni Sikhauli, Lipalo Mokete, Department of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, Gauteng, South Africa
Josip Nenad Cakic, Department of Orthopaedic Surgery, Life Fourways, Johannesburg 2193, Gauteng, South Africa
Author contributions: Pietrzak JRT and Cakic JN designed the manuscript; Pietrzak JRT and Mokete L supervised the study; Pietrzak JRT, Maharaj Z, and Erasmus M drafted the manuscript; Maharaj Z and Mokete L reviewed the manuscript; Maharaj Z and Erasmus M analyzed the data; Sikhauli N collected the data; All authors read and approved the final manuscript.
Institutional review board statement: Medical clearance was obtained from the University of the Witwatersrand Human Research Ethics Committee (Medical) registered with the National Health Research Ethics Council (NHREC) of the national Department of Health Clearance Certificate No. M200681.
Conflict-of-interest statement: All authors declare neither financial nor non-financial conflicts of interest that are directly or indirectly related to this study.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author, JRT Pietrzak at jrtpietrzak@yahoo.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zia Maharaj, MBChB, Doctor, Research Fellow, Department of Orthopaedic Surgery, Charlotte Maxeke Johannesburg Academic Hospital, Jubilee Street, Parktown, Johannesburg 2193, Gauteng, South Africa. maharajzia@gmail.com
Received: November 23, 2020
Peer-review started: November 23, 2020
First decision: December 24, 2020
Revised: January 6, 2021
Accepted: February 26, 2021
Article in press: February 26, 2021
Published online: March 18, 2021
Processing time: 108 Days and 23.6 Hours
Abstract
BACKGROUND

Elective total joint arthroplasty (TJA) procedures have been postponed as part of the coronavirus disease 2019 (COVID-19) response to avert healthcare system collapse. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures comprise the highest volume of elective procedures performed at health care facilities worldwide.

AIM

To determine the demand for TJA despite the pandemic and the impact of surgery postponement on physical and mental health.

METHODS

We conducted a prospective cross-sectional telephonic interview-based study on patients awaiting THA and TKA at an academic institution in South Africa. The questionnaire consisted of four sections. The first section recorded baseline demographic data and medical co-morbidities, the length of time spent awaiting TJA, and the patients’ desire to undergo elective surgery despite the COVID-19 pandemic. Section 2 and Section 3 assessed the patients’ current physical and mental health, respectively, as a consequence of deferred surgical intervention. The last section established the patients’ perception of the healthcare system’s response to the COVID-19 pandemic and necessity to postpone elective surgery. Patients received counseling and education on the current state of surgery during the COVID-19 pandemic and associated risks. Thereafter, patients were once again asked about their desire to undergo TJA during the COVID-19 pandemic.

RESULTS

We included 185 patients (65.95% female; mean age: 50.28 years) awaiting TJA for a mean of 26.42 ± 30.1 mo. Overall, 88.65% of patients wanted TJA despite the COVID-19 pandemic. Patients awaiting TJA for 1-3 years were 3.3-fold more likely to want surgery than those waiting < 1 year (P < 0.000). Patients with comorbidities were 8.4-fold less likely to want TJA than those with no comorbidities (P = 0.013). After receiving education, the patients wanting TJA decreased to 54.05%. Patients who changed their opinion after education had less insight on the increased morbidity (P = 0.046) and mortality (P = 0.001) associated with COVID-19. Despite awaiting TJA for shorter period (24.7 ± 20.38 mo), patients who continued to demand TJA had greater pain (P < 0.000) and decreased function (P = 0.043) since TJA postponement.

CONCLUSION

There is deterioration in health for patients, who have had elective procedures postponed during the COVID-19 pandemic. Waiting lists should be prioritized for urgency with the re-initiation of elective surgery.

Keywords: Total hip arthroplasty; Total knee arthroplasty; Elective surgery; COVID-19; Waiting lists; Primary total joint arthroplasty

Core Tip: This was a prospective cross-sectional study of patients awaiting elective total joint arthroplasty (TJA) that was postponed during the coronavirus disease 2019 (COVID-19) pandemic. We investigated the demand for elective TJA, impact of surgery postponement on overall health, and the role of patient education regarding the healthcare system’s response during the COVID-19 era. After receiving counseling about the peri-operative risks of COVID-19 infection, patients who continued to demand elective TJA had greater pain and decreased function compared to other patients, despite awaiting surgery for the shortest length of time. Waiting lists should be prioritized for urgency with the re-initiation of elective surgery.