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1.
Orthopade ; 51(5): 403-409, 2022 May.
Article in German | MEDLINE | ID: covidwho-1603174

ABSTRACT

BACKGROUND: The aim of this study was to examine the influence of the COVID-19(coronavirus disease 2019) pandemic on the medical and physiotherapeutic follow-up care after reconstructions of the anterior cruciate ligament. METHODS: 116 patients (72 men and 44 women) who had received a reconstruction of the anterior cruciate ligament between September 2019 and December 2020 were included in this study. These patients were divided into two groups depending on the date of surgery: one group that had received surgery in 2019 before the COVID-19 pandemic and one group that had undergone surgery in 2020 and was directly affected by the COVID-19 pandemic. All patients were interviewed using a standardized questionnaire regarding the influence of the coronavirus pandemic on the medical and physiotherapeutic follow-up care, as well as the moment of return to work. In addition, the range of motion of the respective knee 3 months postoperatively was analysed based on physical examination. RESULTS: At 3 months postoperatively, patients who had undergone surgery in 2020 showed a clear trend towards a higher frequency of extension deficits of ≥ 5° (18.8% vs. 4.3%, p = 0.097) or an inability to bend the knee ≥ 120° (23.3% vs. 10%, p = 0.197) compared to those who had received surgery in 2019. Patients who had undergone surgery in 2020 reported significantly longer delays for appointments, a higher number of futile attempts to get an appointment and a higher number of cancelled appointments, regarding both medical and physiotherapeutic follow-up care. 34.9% of the patients who received surgery in 2020 indicated that they were able to reduce the duration of their sick leave due to the increased possibilities of working in a home-office situation during the pandemic. Alternative treatment options due to the pandemic were offered by 13.3% of the physiotherapists and 12.2% of the physicians. CONCLUSION: Although the physiotherapeutic and medical follow-up care was not directly affected by a "lockdown", the pandemic led to significant restrictions, which are also reflected in a clear trend towards worse clinical outcomes. Consequently, a further expansion of alternative treatment options, which were only offered by 12-13% of practices and that are presumably of comparable relevance for various other diseases, is needed.


Subject(s)
Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament Reconstruction , COVID-19 , Aftercare , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Injuries/epidemiology , Anterior Cruciate Ligament Injuries/surgery , COVID-19/epidemiology , Female , Follow-Up Studies , Humans , Knee Joint/surgery , Male , Pandemics , Treatment Outcome
2.
J Clin Med ; 10(5)2021 Mar 04.
Article in English | MEDLINE | ID: covidwho-1136504

ABSTRACT

Due to the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic, a large number of elective knee replacement procedures had to be postponed in both early and late 2020 in most western countries including Germany and the UK. It is unknown how public interest and demand for total knee arthroplasties was affected. Public interest in knee pain, knee osteoarthritis and knee arthroplasty in Germany and the UK was investigated using Google Trend Analysis. In addition, we monitored for changes in patient composition in our outpatient department. As of early March in Germany and of late March in the UK, until the lockdown measures, a 50 to 60% decrease in relative search frequency was observed in all categories investigated compared to the beginning of the year. While public interest for knee pain rapidly recovered, decreased interest for knee osteoarthritis and replacement lasted until the easing of measures. Shortly prior to and during the first lockdown mean search frequency for knee replacement was significantly decreased from 39.7% and 36.6 to 26.9% in Germany and from 47.7% and 50.9 to 23.7% in the UK (Germany: p = 0.022 prior to lockdown, p < 0.001 during lockdown; UK: p < 0.0001 prior to and during lockdown). In contrast, mean search frequencies did not differ significantly from each other for any of the investigated time frames during the second half of 2020 in both countries. Similarly, during the first lockdown, the proportion of patients presenting themselves to receive primary knee arthroplasty compared to patients that had already undergone knee replacement declined markedly from 64.7% to 46.9%. In contrast, patient composition changed only marginally during the lockdown measures in late 2020 in both Germany and the UK. We observed a high level of public interest in knee arthroplasty despite the ongoing pandemic. The absence of a lasting decline in interest in primary knee arthroplasty suggests that sufficient symptom reduction cannot be achieved without surgical care for a substantial number of patients.

3.
PLoS One ; 16(2): e0246956, 2021.
Article in English | MEDLINE | ID: covidwho-1085151

ABSTRACT

BACKGROUND: The COVID-19 pandemic led to the implementation of drastic shutdown measures worldwide. While quarantine, self-isolation and shutdown laws helped to effectively contain and control the spread of SARS-CoV-2, the impact of COVID-19 shutdowns on trauma care in emergency departments (EDs) remains elusive. METHODS: All ED patient records from the 35-day COVID-19 shutdown (SHUTDOWN) period were retrospectively compared to a calendar-matched control period in 2019 (CTRL) as well as to a pre (PRE)- and post (POST)-shutdown period in an academic Level I Trauma Center in Berlin, Germany. Total patient and orthopedic trauma cases and contacts as well as trauma causes and injury patterns were evaluated during respective periods regarding absolute numbers, incidence rate ratios (IRRs) and risk ratios (RRs). FINDINGS: Daily total patient cases (SHUTDOWN vs. CTRL, 106.94 vs. 167.54) and orthopedic trauma cases (SHUTDOWN vs. CTRL, 30.91 vs. 52.06) decreased during the SHUTDOWN compared to the CTRL period with IRRs of 0.64 and 0.59. While absolute numbers decreased for most trauma causes during the SHUTDOWN period, we observed increased incidence proportions of household injuries and bicycle accidents with RRs of 1.31 and 1.68 respectively. An RR of 2.41 was observed for injuries due to domestic violence. We further recorded increased incidence proportions of acute and regular substance abuse during the SHUTDOWN period with RRs of 1.63 and 3.22, respectively. CONCLUSIONS: While we observed a relevant decrease in total patient cases, relative proportions of specific trauma causes and injury patterns increased during the COVID-19 shutdown in Berlin, Germany. As government programs offered prompt financial aid during the pandemic to individuals and businesses, additional social support may be considered for vulnerable domestic environments.


Subject(s)
COVID-19/epidemiology , Fractures, Bone/epidemiology , Quarantine/statistics & numerical data , Trauma Centers/statistics & numerical data , COVID-19/prevention & control , Fractures, Bone/classification , Fractures, Bone/etiology , Germany , Hospitals, University/statistics & numerical data , Humans
4.
PLoS One ; 15(9): e0238759, 2020.
Article in English | MEDLINE | ID: covidwho-748976

ABSTRACT

OBJECTIVES: The purpose of this study was to assess the impact of the COVID-19 pandemic on orthopedic and trauma surgery in private practices and hospitals in Germany. DESIGN: In this cross-sectional study, an online-based anonymous survey was conducted from April 2th to April 16th 2020. SETTING: The survey was conducted among 15.0000 of 18.000 orthopedic and trauma surgeons in Germany, both in private practices and hospitals. PARTICIPANTS: All members of the German Society of Orthopedic and Trauma Surgery (DGOU) and the Professional Association for Orthopedic and Trauma Surgery (BVOU). were invited by e-mail to participate in the survey. MAIN OUTCOME MEASURES: Out of 50 questions 42 were designed to enquire a certain dimension of the pandemic impact and contribute to one of six indices, namely "Preparedness", "Resources", "Reduction", "Informedness", "Concern", and "Depletion". Data was analyzed in multiple stepwise regression, aiming to identify those factors that independently influenced the indices. RESULTS: 858 orthopedic and trauma surgeons participated in the survey throughout Germany. In the multiple regression analysis, being employed at a hospital was identified as an independent positive predictor in the indices for "Preparedness", "Resources", and "Informedness" and an independent negative predictor regarding "Depletion". Self-employment was found to be an independent positive predictor of the financial index "Depletion". Female surgeons were identified as an independent variable for a higher level of "Concern". CONCLUSIONS: The study confirms a distinct impact of the COVID-19 pandemic on orthopedic and trauma surgery in Germany. The containment measures are largely considered appropriate despite severe financial constraints. A substantial lack of personal protective equipment (PPE) is reported. The multiple regression analysis shows that self-employed surgeons are more affected by this shortage as well as by the financial consequences than surgeons working in hospitals. WHAT ARE THE NEW FINDINGS: The COVID-19 pandemic has a profound impact on orthopedic and trauma surgery as an unrelated specialty. Self-employed surgeons are affected especially by a shortage of PPE and financial consequences. HOW MIGHT IT IMPACT ON CLINICAL PRACTICE IN THE NEAR FUTURE: Political and financial support can now be applied more focused to subgroups in the field of orthopedics and trauma surgery with an increased demand for support. A special emphasis should be set on the support of self-employed surgeons which are a more affected by the shortage of PPE and financial consequences than surgeons working in hospitals.


Subject(s)
Coronavirus Infections/pathology , Pneumonia, Viral/pathology , Surgeons/psychology , Adult , Aged , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/virology , Cross-Sectional Studies , Delivery of Health Care , Female , Germany , Hospitals , Humans , Internet , Male , Middle Aged , Orthopedic Procedures , Pandemics , Personal Protective Equipment , Pneumonia, Viral/virology , SARS-CoV-2 , Surveys and Questionnaires
5.
J Bone Joint Surg Am ; 102(14): e78, 2020 Jul 15.
Article in English | MEDLINE | ID: covidwho-325181

ABSTRACT

BACKGROUND: The purpose of the present study was to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on orthopaedic and trauma surgery departments in university hospitals in Germany in order to clarify current challenges. METHODS: In this cross-sectional study, an online-based anonymous survey was conducted within the Convention of University Professors of Orthopaedic and Trauma Surgery in Germany from April 3 to April 11, 2020. A bipolar 5-point Likert scale (with possible responses of "totally disagree," "rather disagree," "neutral," "rather agree," and "totally agree") was applied. Fifty-two (69.3%) of 75 clinic directors participated. RESULTS: Communication and cooperation with the government, hospital administration, and other departments during the COVID-19 pandemic were mainly perceived as appropriate. However, only 7 respondents (13.7%) totally agreed or rather agreed with the statement that the authorities are supporters of orthopaedic and trauma surgery departments. Substantial financial and personnel changes in orthopaedic and trauma surgery departments of university hospitals were reported, resulting in an average reduction of 49.4% in operating room capacity and an expected 29.3% loss of revenue. In addition, 14.7% of physicians were reallocated from orthopaedic and trauma surgery to other care-delivery environments. CONCLUSIONS: Our study demonstrated that the COVID-19 pandemic has had a substantial impact on orthopaedic and trauma surgery departments in German university hospitals. Distinct structural and financial effects were noted. Nevertheless, the present study demonstrates the commitment of our specialty to overcome the pandemic by providing competent personnel as well as close cooperation with the hospital administration and other departments. CLINICAL RELEVANCE: To our knowledge, this is the first Germany-wide survey among the heads of orthopaedic and trauma surgery departments in university hospitals on the impact of the COVID-19 pandemic. The survey results may help to inform system-wide decision-making in Germany, in Europe, and beyond.


Subject(s)
Coronavirus Infections/epidemiology , Hospitals, University/organization & administration , Orthopedics/organization & administration , Pneumonia, Viral/epidemiology , Trauma Centers/organization & administration , Betacoronavirus , COVID-19 , Cross-Sectional Studies , Delivery of Health Care/statistics & numerical data , Germany/epidemiology , Health Care Surveys , Humans , Orthopedic Procedures , Orthopedic Surgeons , Pandemics , SARS-CoV-2
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