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National operating volume for primary hip and knee arthroplasty in the COVID-19 era: a study utilizing the Scottish
Liam Z Yapp1,2, Jon V Clarke2,3, Matthew Moran1,2,4
1Department of Orthopaedics, University of Edinburgh, Edinburgh, UK.
Insights
The COVID-19 pandemic significantly reduced hip and knee replacement surgeries in Scotland. Restarting services has been slow, with hospitals operating at half capacity, leading to substantial backlogs for these essential procedures.
Area of Science:
- Orthopedic Surgery
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic caused widespread disruption to elective surgical procedures globally.
- Non-urgent hip and knee arthroplasty services in Scotland were suspended nationally.
- Assessing the pandemic's impact on arthroplasty volumes is crucial for service recovery.
Purpose of the Study:
- To quantify the effect of the COVID-19 pandemic on total hip arthroplasty (THA) and total knee arthroplasty (TKA) volumes in Scotland.
- To evaluate the success of restarting elective arthroplasty services.
- To model the time needed to address the surgical backlog.
Main Methods:
- Retrospective observational study using the Scottish Arthroplasty Project dataset (2008-2020).
- Negative binomial regression used to model future case volumes.
- Comparison of monthly case volumes before and after the pandemic-induced suspension.
Main Results:
- Primary TKA and THA volumes decreased by 61.1% and 53.6%, respectively, compared to the 2008-2019 baseline.
- Post-suspension, Scottish hospitals operated at 40%-50% of baseline monthly activity.
- Over four years of 120% baseline activity are needed to clear the backlog.
Conclusions:
- The COVID-19 pandemic severely impacted THA and TKA volumes in Scotland.
- Reduced operating capacity post-pandemic leads to significant treatment delays.
- Increased delays are likely to exacerbate patient morbidity.
Aims:
The COVID-19 pandemic led to a national suspension of "non-urgent" elective hip and knee arthroplasty. The study aims to measure the effect of the COVID-19 pandemic on total hip arthroplasty (THA) and total knee arthroplasty (TKA) volume in Scotland. Secondary objectives are to measure the success of restarting elective services and model the time required to bridge the gap left by the first period of suspension.
Methods:
A retrospective observational study using the Scottish Arthroplasty Project dataset. All patients undergoing elective THAs and TKAs during the period 1 January 2008 to 31 December 2020 were included. A negative binomial regression model using historical case-volume and mid-year population estimates was built to project the future case-volume of THA and TKA in Scotland. The median monthly case volume was calculated for the period 2008 to 2019 (baseline) and compared to the actual monthly case volume for 2020. The time taken to eliminate the deficit was calculated based upon the projected monthly workload and with a potential workload between 100% to 120% of baseline.
Results:
Compared to the period 2008 to 2019, primary TKA and THA volume fell by 61.1% and 53.6%, respectively. Since restarting elective services, Scottish hospitals have achieved approximately 40% to 50% of baseline monthly activity. With no changes in current workload, by 2021 there would be a reduction of 9,180 and 10,170 for THA and TKA, respectively. Conversely, working at 120% baseline monthly output, it would take over four years to eliminate the deficit for both TKA and THA.
Conclusion:
This national study demonstrates the significant impact that COVID-19 pandemic has had on overall THA and TKA volume. In the six months after resuming elective services, Scottish hospitals averaged less than 50% normal monthly output. Loss of operating capacity will increase treatment delays and likely worsen overall morbidity. Cite this article: Bone Joint Open 2021;2(3):203-210.
