Elective joint surgeries were safe and effective during the COVID-19 pandemic: a retrospective cohort study in Washington State

Abstract

Introduction The cancelation of elective joint procedures left patients affected with debilitating osteoarthritis unsure of when their joint replacement operation would take place. Our primary aim in this study was to assess the safety of total hip and knee arthroplasty (THA, TKA) during an active pandemic and to determine if patient outcomes changed after a State of Emergency declaration. Methods This retrospective cohort study evaluated the outcomes of patients who received a THA or TKA in Yakima County, a region in Washington State which had the most COVID-19 infections per capita at the time of the initial surge in 2020. Patients were stratified between a control group and COVID-19 group depending on if their surgery was before or after the cancellation of all elective surgeries on March 19th, 2020. Demographics, surgical notes, COVID-19 test status, functional outcomes, and adverse events were collected. Chi-square and t-tests were utilized to analyze differences between categorical and continuous variables, respectively. Results Inclusion criteria was met for 90 patients for the control group and 490 patients for the COVID-19 group. There were no differences between the cohorts in age, BMI, ethnicity, Charlson Comorbidity Index scores, insurance status, or procedure type. There were four recorded COVID-19 infections from patients in the COVID-19 group (p=0.39); zero of which had complications related to their postoperative care. In comparing our control group to COVID-19 group, no significant differences were observed in postoperative emergency room visits (2.2% vs 6.3% respectively (p=0.126)), hospital readmissions ( 2.2% vs 3.9% respectively (p=0.447)), or any adverse events ( 5.6% vs 7.3% respectively (p=0.073)). Visual analogue pain scores, Lower Extremity Functional scores, and range of motion at one week and three months postoperative were not significantly different between either group. Discussion Our comparison between these patient cohorts showed no significant differences in the rate of postoperative adverse events, functional outcome scores, or complications from COVID-19 infections. Thus, with the proper precautions, elective joint replacement surgery may be done safely during a State of Emergency declaration for an active pandemic.