Arthroplasty-in the Age of COVID-19
Arthroplasty, otherwise known as joint replacement, has been among the most successful surgical procedures ever developed. Prior to the onset of COVID-19, the annual number of arthroplasty patients was climbing precipitously. The reasons often offered for this increase are simply that they work, the long healthy lifespan increasing the eligible population, the higher lifestyle expectations expected for the retirement population, and some of the limited alternate options which have been taken off the market.
The goal of any arthroplasty is to relieve pain, improve function and quality of life.
With the onset of the COVID pandemic, national guidelines, and simple fear of contracting the illness placed episodes of temporary halting on arthroplasty surgery. The stated goals of suspending arthroplasty surgery were to make room for patients in more critical need of care. The other reason was to minimize exposure of otherwise healthy patients to COVID-19 positive patients and caregivers. While the “science” and the “data” can be debated, the human fear factor appropriately caused hesitation in submitting to this complex intervention. What was not stopped was urgent arthroplasty procedures, such as infections or cancers, where delay would create harm to the individual.
In parallel with the COVID pandemic, which changed the national trends of arthroplasty practice, one of the important trends was patient optimization, improving modifiable risk factors, and the transfer of arthroplasty cases from being done exclusively within the hospital.
This transition allowed for arthroplasty to continue in freestanding surgical suites, limiting close inpatient contact with severely afflicted COVID patients. While screening for comorbidities and risk factors may optimize patient candidates for this more limited environment, no scoring system is perfect. There is always the possibility that medical complications can occur requiring a transfer to a hospital. If one is not prepared for this possibility, waiting perhaps until COVID-19 counts go down would be the correct answer. Other options could be to have patients who had early surgeries go home the same day, or patients could stay overnight in a short procedure unit with a nurse available.
Considering whether to have a joint replaced is a very personal experience and asking questions about the steps along the way is helpful. The risks have come down significantly but still persist. In the meantime, should you choose to proceed, best wishes?
Dr. Menachem M. Meller, M.D., Ph.D., FAAOS
To schedule an appointment with Dr. Menachem M. Meller, call one of our convenient locations.
Lower Bucks Hospital, Bristol (215) 785-9818 and Town Center Drive, Langhorne (267) 789-2074