key: cord-0963985-fh7236at
authors: Brown, Timothy S.; Bedard, Nicholas A.; Rojas, Edward O.; Anthony, Christopher A.; Schwarzkopf, Ran; Stambough, Jeffrey B.; Nandi, Sumon; Prieto, Hernan; Parvizi, Javad; Bini, Stefano A.; Higuera, Carlos A.; Piuzzi, Nicholas S.; Blankstein, Michael; Wellman, Samuel S.; Dietz, Matthew J.; Jennings, Jason M.; Dasa, Vinod
title: A BRIEF UPDATE ON THE EFFECT OF THE COVID-19 PANDEMIC ON HIP AND KNEE ARTHROPLASTY PATIENTS IN THE UNITED STATES A Multicenter Update to a Previous Survey Study of Patients Postponed by the Pandemic
date: 2020-12-03
journal: Arthroplast Today
DOI: 10.1016/j.artd.2020.11.025
sha: aeaa3e60235bb51e22f64dfd39a0fdfbb91df042
doc_id: 963985
cord_uid: fh7236at

BACKGROUND: In March 2020 elective total hip and knee arthroplasty (THA and TKA) were suspended across the United States in response to the COVID-19 pandemic. We had previously published the results of a survey to the affected patients from 6 institutions. We now present the results of a larger distribution of this survey, through May and June 2020, to electively scheduled patients representing different regions of the United States. METHODS: Fifteen centers identified through the AAHKS Research Committee participated in a survey study of THA and TKA patients. Patients scheduled for primary elective THA or TKA but canceled due to the COVID-19 elective surgery stoppage (3/2020-5/2020) were included in the study. Descriptive statistics along with subgroup analysis with Wilcoxon rank were performed. RESULTS: In total, surveys were distributed to 2135 patients and completed by 848 patients (40%) from 15 institutions. Most patients (728/848, 86%) had their surgery postponed or canceled by the surgeon or hospital. Unknown length of surgical delay remained the highest source of anxiety among survey participants. Male patients were more likely to be willing to proceed with surgery in spite of COVID-19. There were minimal regional differences in responses. Only 61 patients (7%) stated they will continue to delay surgery for fear of contracting COVID-19 while in the hospital. CONCLUSION: Similar to the previous study, the most anxiety-provoking thought was the uncertainty over if and when the canceled joint replacement surgery could be rescheduled. Patients suffering from the daily pain of hip and knee arthritis that have been scheduled for elective arthroplasty remain eager to have their operation as soon as elective surgery is allowed to resume.

J o u r n a l P r e -p r o o f ABSTRACT 6 7

Background 8 9

In March 2020 elective total hip and knee arthroplasty (THA and TKA) were suspended 10 across the United States in response to the COVID-19 pandemic. We had previously published 11 the results of a survey to the affected patients from 6 institutions. We now present the results of a 12 larger distribution of this survey, through May and June 2020, to electively scheduled patients 13

representing different regions of the United States. 14 15

Methods 16

survey study of THA and TKA patients. Patients scheduled for primary elective THA or TKA 18 but canceled due to the COVID-19 elective surgery stoppage (3/2020-5/2020) were included in 19 the study. Descriptive statistics along with subgroup analysis with Wilcoxon rank were 20 performed. 21

In total, surveys were distributed to 2135 patients and completed by 848 patients (40%) 23 from 15 institutions. Most patients (728/848, 86%) had their surgery postponed or canceled by 24 the surgeon or hospital. Unknown length of surgical delay remained the highest source of anxiety 25 among survey participants. Male patients were more likely to be willing to proceed with surgery 26 in spite of COVID-19. There were minimal regional differences in responses. Only 61 patients 27 (7%) stated they will continue to delay surgery for fear of contracting COVID-19 while in the 28

Conclusion 30 J o u r n a l P r e -p r o o f Similar to the previous study, the most anxiety-provoking thought was the uncertainty 31 over if and when the canceled joint replacement surgery could be rescheduled. Patients suffering 32

In response to the novel coronavirus SARS-CoV-2 and the global pandemic, we saw the 38 cancellation of elective surgery across the United States (US) starting in March 2020 [1, 2] . Hip We previously obtained Institutional Review Board (IRB) approval to administer a 55 questionnaire to patients with hip and knee arthritis that had planned for elective hip or knee 56 arthroplasty but were rescheduled due to the pandemic (Figure 1 -Survey). Participating centers 57

were identified through the AAHKS Research Committee and Research Consortium. In total, 58 fifteen institutions obtained local IRB approval and distributed the survey items to patients. 59

United States (Table 1 -Participating Institutions) . 61

The survey was distributed to patients via telephone or electronically with REDCap 62 Younger patients (<65 yo) were significantly more likely to have more anxiety overall 94 and specifically with finances (mean of 2.5 vs 1.9, p<0.0001), Job Security/leave/disability 95 (mean of 2.2 vs 1.4, p<0.0001), and length of surgical delay (mean of 3.5 vs 3.1, p<0.0001) 96 (Table 3 ). There were no significant differences in response by patient sex or by procedure type. 97 98

Patients reported being at the same symptom level (37%) or had worsening arthritis 100 symptoms during the pandemic (54%). Very few had improved hip or knee arthritis symptoms 101 during the pandemic. Most patients report becoming less active during the pandemic (50%) and 102 there were no differences in age or sex (Table 4) . Patients with hip arthritis were more likely to 103 report worsening symptoms during the pandemic compared to knee patients (67% vs 48%, p < 104 0.0001). 105

Male patients were more likely to be willing to proceed with surgery in spite of COVID-108 19 risk (47% vs 30%, p < 0.0001) and less likely to agree that elective surgery should be stopped 109 to help limit the spread of COVID-19 (71% vs 85%, p < 0.0001). Younger patients (< 65) were 110 significantly more likely to accept the risk of COVID-19 and pursue surgery during the 111 pandemic (44% vs 31%, p < 0.0001). 112

There were minimal regional differences in responses, with the only significant 113 differences coming in regional response to the question "I agree with the importance of stopping 114 elective surgery during the pandemic to minimize infection risk" (Midwest 77% yes, Northeast 115 82% yes, South 83% yes, West 60% yes; p = 0.0018). 116 117

When asked about future plans for arthritis treatment, 736 patients (87%) stated 119 they will reschedule surgery in the near future. Only 61 patients (7%) stated they will delay 120 surgery for fear of contracting the virus while in the hospital. There were not regional differences 121 to the survey responses for this question. consistently worried more about finances and job security relative to the retirement age 136 respondents. As the pandemic spread more broadly throughout the US, the regional differences 137 in responses seen in the April survey results were no longer significant. J o u r n a l P r e -p r o o f J o u r n a l P r e -p r o o f 

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