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Consequences for preoperative pain and function when postponing elective knee and hip arthroplasty
Lasse K Harris1, Lina H Ingelsrud1, Kirill Gromov1
1Department of Orthopaedic Surgery, Copenhagen University Hospital - Hvidovre Hospital, Denmark.
Insights
Patients undergoing elective knee and hip arthroplasty experienced significant deterioration and concern due to surgery postponement during the coronavirus outbreak. However, patient-reported outcomes for pain and function did not significantly change despite their perceived worsening condition.
Area of Science:
- Orthopaedic Surgery
- Public Health
Background:
- The coronavirus pandemic led to the postponement of elective surgeries, including knee and hip arthroplasty.
- This study investigated the impact of these postponements on patients with osteoarthritis.
Purpose of the Study:
- To evaluate the effects of postponed elective knee and hip arthroplasty on patient pain, function, and general health.
- To assess patient concerns and perceived changes in condition during the waiting period.
Main Methods:
- 194 patients with postponed elective knee or hip arthroplasty participated.
- Patient-reported outcomes were collected using Oxford Knee and Hip Scores (OKS, OHS) and EuroQol 5-dimension scale (EQ5D).
- Data were collected at surgery cancellation and before rescheduled surgery, assessing pain, function, general health, and patient concerns.
Main Results:
- Complete data were available for 110 patients (57%), with a median postponement of 98 days.
- 34% of patients worried about poorer outcomes, and 68% felt their condition had deteriorated.
- Mean OKS/OHS and EQ5D index differences showed no significant change from cancellation to rescheduled surgery.
Conclusions:
- Patients awaiting knee and hip arthroplasty expressed significant pre-operative anxiety regarding treatment outcomes due to surgical delays.
- Despite subjective feelings of deterioration, patient-reported outcome measures for pain and function remained largely unchanged.
- This highlights a discrepancy between patient perception and objective outcome measures following postponed arthroplasty.
Introduction:
The coronavirus outbreak causes postponement of elective surgery. We evaluated how pain, function and general health were impacted by postponing elective knee and hip arthroplasty in patients with knee and hip osteoarthritis with no known surgery rescheduling date due to the coronavirus outbreak.
Methods:
This study included 194 patients from a Danish public hospital with postponed elective primary knee or hip arthroplasty due to the lockdown. Patients responded to questionnaires when their surgery was cancelled and before surgery. Changes in pain and function were evaluated with the Oxford Knee and Hip Scores (OKS, OHS) and their general health with the EuroQol 5-dimension scale (EQ5D). Additionally, we asked about the patients' concerns and whether they felt improved, unchanged or deteriorated during the waiting period.
Results:
Complete data were obtained for 110 (57%) patients, 59 and 51 awaiting knee or hip arthroplasty (median age 71 years, 62% were female), respectively. Arthroplasty was postponed for a median (range) 98 (63-161) days. A total of 34% were concerned that the postponement would lead to a poorer outcome. Mean OKS and OHS differences were 0 (95% confidence interval (CI): -1-1) and -1 (95% CI: -2-0) from surgery cancellation to re-scheduled surgery. The mean EQ5D index difference was 0.0 (95% CI: 0.0-0.1) for both groups. A total of 75 (68%) patients felt an important deterioration of their condition.
Conclusions:
Pre-operatively, patients worried about experiencing an altered treatment outcome due to postponed surgery and felt that their condition had deteriorated during the waiting period although this was not reflected in patient-reported outcome measures.
Funding:
Department of Orthopaedic Surgery.
Trial Registration:
not relevant.
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