The Impact of the COVID-19 Pandemic on Orthopaedic Knee Procedures: A National Multicentered Analysis.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic strained the United States healthcare system, and associated policies resulted in the postponement or cancellation of many elective surgeries. While most orthopaedic surgeons are aware of how the pandemic affected their patients' care, broader national trends in the operative treatment of orthopaedic knee pathology are poorly characterized. Therefore, the purpose of this study was to identify trends in orthopaedic knee procedures during the COVID-19 pandemic. METHODS: The TriNetX database was queried for orthopaedic knee procedures performed from March 2018 to May 2021. Procedures were classified as arthroplasty (total knee arthroplasty (TKA), revision total knee arthroplasty) or non-arthroplasty (tendon or ligament repair, fracture fixation). Procedural volume per healthcare organization was determined over five seasons from March 2020 to May 2021 and compared to overlapping pre-pandemic periods from March 2018 to May 2019. Descriptive analysis was performed, and comparisons were made using a Student's T-test. RESULTS: Compared to the pre-pandemic period, there were significant decreases in primary TKA (p=0.016), femoral or entire tibial component revision TKA (p=0.005), and open treatment of femoral shaft fractures (p=0.007) in spring 2020. Procedural volume returned to baseline in summer 2020 through winter 2021. In spring 2021, primary TKA (p=0.017) and one component revision TKA (p=0.003) increased compared to the pre-pandemic period. CONCLUSION: The greatest decrease in knee procedures occurred early in the pandemic. Rates of these procedures have since rebounded, with some exceeding pre-pandemic levels. Hospitals are now better able to accommodate orthopaedic surgical volume while continuing to care for patients with COVID-19.

Postoperative Complications in Patients With Hereditary Hemochromatosis Undergoing Total Joint Arthroplasty: A Matched Cohort Analysis.

AIMS: The purpose of this study is to determine differences in the rates of 90-day postoperative complications and 2- and 5-year surgical outcomes between patients with and without hereditary hemochromatosis (HH) after total joint arthroplasty (TJA). METHODS: Patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) from 2010 to 2018 were identified in a national database (PearlDiver Technologies) using Current Procedural Terminology and International Classification of Diseases-9/10 codes. Patients with a history of HH were identified within the THA and TKA cohorts and matched with non-HH patients based on age, sex, Charlson Comorbidity Index, smoking status, and obesity (body mass index > 30). Ninety-day medical complications assessed included renal failure, arrhythmia, bleeding complications, blood transfusion, pneumonia, stroke, deep vein thrombosis, liver failure, heart failure, pulmonary embolism, sepsis, surgical site infection, wound dehiscence, readmission rate, and death. Two- and 5-year surgical complications assessed included all-cause revision, prosthetic joint infection, implant loosening, joint stiffness, and manipulation under anesthesia. All complications were analyzed using bivariate analysis and logistic regression, with significance set at P < 0.05. RESULTS: Compared with non-HH patients, patients with HH had higher rates of stiffness at 2 and 5 years after THA (all, P < 0.001), as well as higher rates of aseptic loosening at 5 years after TKA (P = 0.036). However, patients with HH undergoing THA and TKA had no notable difference in 90-day postoperative complications when compared with non-HH patients. DISCUSSION: Compared with non-HH patients, patients with HH undergoing TJA were shown to have worse 2- and 5-year surgical outcomes, without any increased risk of 90-day medical complications. These findings may be useful for surgical decision making for patients with HH undergoing TJA. CLINICAL RELEVANCE: This study addresses a paucity in the current literature concerning the complication profile in HH patients with destructive joint arthropathy undergoing joint arthroplasty surgery.

Age and Racial Disparities in Telemedicine Utilization in an Academic Orthopedic Surgery Department.

Introduction: The COVID-19 pandemic has highlighted significant racial and age-related health disparities. In response to pandemic-related restrictions, orthopedic surgery departments have expanded telemedicine use. We analyzed data from a tertiary care institute during the pandemic to understand potential racial and age-based disparities in access to care and telemedicine utilization. Materials and Methods: Data on patient race and age, and numbers of telemedicine visits, in-person office visits, and types of telemedicine were extracted for time periods during and preceding the pandemic. We calculated odds ratios for visit occurrence and type across race and age groups. Results: Patients ages 27-54 were 1.3 (95% confidence interval [CI] 1.1-1.4, p < 0.01) and 1.2 (95% CI 1.0-1.3, p < 0.05) times more likely to be seen than patients <27 during the pandemic, versus the 2019 and 2020 controls. Patients 54-82 were 1.3 (95% CI 1.1-1.5, p < 0.001) times more likely to be seen than patients <27 during the pandemic versus the 2019 control. Patients 27-54, 54-82, and 82+, respectively, were 3.3 (95% CI 2.6-4.2, p < 1e-20), 3.5 (95% CI 2.8-4.4, p < 1e-24), and 1.9 (95% CI 1.1-3.4, p < 0.05) times more likely to be seen by telemedicine than patients <27. Among pandemic telemedicine appointments, Black patients were 1.5 (95% CI 1.2-1.9, p < 1e-3) times more likely to be seen by audio-only telemedicine than White patients, as compared with video telemedicine. Conclusions: Telemedicine access barriers must be reduced to ensure that disparities during the pandemic do not persist.