A Retrospective Analysis of Effect of COVID-19 on Revision Total Knee and Hip Arthroplasty

ABSTRACT

Background: The SARS-CoV-2 (Covid-19) has significantly impacted the health of the people around the globe. Primary Total Hip arthroplasty (THA) and Total Knee arthroplasty (TKA) were significantly affected in the pandemic time. The canceled surgeries of THA and TKA were rescheduled as majority of the beds in the hospitals were occupied by COVID patients. Due to this, patients for such surgery accumulated and many patients faced serious health issues. In addition to THA and TKA, Covid-19 pandemic also significantly impacted Total Joint arthroplasty (TJA) volume. According to analysis, the annual volume of the TKA and THA for 2020 was around 128,000 and 66,000 respectively. Aim: To analyze the effect of COVID-19 on revision total knee and hip arthroplasty. Methods: For the study, the data was collected from the institutional registry for TJA and pending revisions for the TKA and THA patients. Approximately 465 inpatient beds between April 2019 and March 2020 considered for the study. Procedures were conducted for 12 months prior to the initial shutdown of elective surgery (April 19 – March 20). The percentage changes for urgent revisions for TJA were compared focusing on pre and post-Covid TKA and THA. Results: Two groups were defined as pre-Covid patients (n = 190) and post-Covid patients (n= 160). The mean age of the patient in pre-Covid group was 75.3 years (SD = 1.01) and post-Covid group was 68.9 years (SD = 11.52). For TKA revision, in pre-covid group, 33.3% of the patients had Aseptic loosening and 22.2% had Periprosthetic joint infection, and 16.6% required Urgent revision. On the other hand, in post-Covid group, 33.3% of the patients had Aseptic loosening and 21.2% had Periprosthetic joint infection, and 18.1% required Urgent revision. Post-Covid cases of THA were also increased as out of 94 patients, 15.9% required Urgent revision. There was no significant difference between the groups for TKA revision (p>0.05). Similarly, apart from Aseptic loosening (p<0.05), there was no significant difference between the groups for THA revision (p>0.05). Conclusion: It has been carried out that revision of TKA and THA decreased in health care system during Covid-19 pandemic compared to pre-Covid. The numbers of urgent cases were increased in both groups such as the numbers of urgent cases for THA were 15.9% and TKA was 18.1% post-Covid and these are creating the backlog for the care professionals to provide the better treatment and recovery of the patients.