key: cord-0757170-umq5z3ek
authors: Robinson, Matthew G.; Greene, Nattaly; Katakam, Akhil; Chen, Antonia; Bedair, Hany S.; Humphrey, Tyler; Melnic, Christopher M.
title: The effect of the COVID-19 pandemic on revision total hip and knee arthroplasty at a large academic hospital network
date: 2021-11-24
journal: J Orthop
DOI: 10.1016/j.jor.2021.11.012
sha: 531f3fbb97b42f49fd7148265eff9ea1581973a5
doc_id: 757170
cord_uid: umq5z3ek

We sought to quantify the impact of COVID-19 on canceled revision total joint arthroplasty (TJA) in a large academic hospital network. We performed a retrospective analysis of revision TKA and THA in a healthcare system containing 5 hospitals in a time period of 8 months prior to and 8 months after the cessation of elective surgery. We found a 30.1% decrease in revision TKA and a 6.80% decrease in revision THA. Revision TJA volume decreased in our healthcare system during COVID-19 compared to prior to the pandemic, which will likely have lasting financial and clinical ramifications for the healthcare system.

cases. There were no significant differences between revision THA indications between the two 141 time periods, with the exception of a significant decrease in aseptic loosening as an indication for 142 revision THA from the pre-pandemic time period to the time period after the shutdown (p=0.04) 143 (Table 1) (27.5%), but a lower percentage reduction in revision THA cases (6.8%) compared to primary 154 THA (13.6%). The decrease in revision THA and TKA when compared to the decrease in 155 primary THA and TKA was not statistically significant (Table 1) . 156 to our knowledge, has published the effects of revision TJA volume on their healthcare system 163 based on volume and indications with comparison to primary TJA volume. 164 165 There was no statistically significant difference between the two groups in terms of demographic 166 information such as age, sex, and BMI. There was a 30.1% decrease in revision TKA and a 167 6.8% decrease in revision THA 8 months prior to the pandemic to 8 months after this initial 168 shutdown of elective surgery. However, this revision THA and TKA volume did not reduce in a 169 greater proportion than primary THA and TKA volume in our healthcare system as we 170 hypothesized. We suspected that there would be a larger decrease in revision TJA surgery due to 171 the restrictions on inpatient surgery and need to preserve inpatient beds. However, in our 172 hospital system, there was a proportional decrease in revision TJA compared to primary TJA 173 (Table 1) . 174

We also sought to determine if the COVID-19 pandemic had a greater effect on more elective 176 revision TJA cases than more urgent cases, like those for periprosthetic joint infection and 177 periprosthetic fracture. We hypothesized that the more urgent indications for revision TJA 178 would stay at a similar volume, while more elective indications for revision TJA would decrease. proportionally from one time period to the next, it is possible some patients that otherwise would 194 be seen for periprosthetic infection deferred or delayed care and that there still could be a future 195 increase in our hospital system. As expected (although it was not statistically significant), there 196 did not seem to be a decrease in periprosthetic fracture from one time period to the next (Table  197   1 

COVID-19 infection: Origin, 231 transmission, and characteristics of human coronaviruses

The Effect of the COVID-19 Pandemic on 234

Electively Scheduled Hip and Knee Arthroplasty Patients in the United States

Reopening of elective total joint replacement surgery in a high-volume single-specialty hospital 238 within a COVID-19 epicenter

World Health Organization: United States

Quantifying the backlog of total hip and knee arthroplasty cases: predicting the impact of 244

Effect of COVID-19 on Hip and Knee Arthroplasty 246

Surgical Volume in the United States