Is it safe to have hip or knee replacement surgery during the COVID-19 pandemic?

In short, the answer is yes provided there are appropriate pathways and systems in place to protect patients.

1. How do you prepare for surgery during COVID-19 pandemic?

First and foremost, it is important that the severity of your joint damage is established by a specialist orthopaedic surgeon with a review of your symptoms, signs and the X-rays. It is important to exhaust all the non-surgical options before proceeding with surgery. This is particularly the case during the COVID-19 pandemic. The surgeon will discuss the risks associated with surgery and the additional risks if you were to contract COVID infection around your surgery. The risk of contracting is also different for individuals.

2. What are the risks of undergoing hip or knee replacement surgery during the pandemic?

There are certain risks associated with undergoing a hip or knee replacement surgery. Albeit, the risks are low and will be discussed by your surgeon when discussing your treatment options. These do not change due to the pandemic. The precise risk of contracting COVID infection is unknown but believed to be very low particularly if the procedures are carried out under COVID safe pathways. The author has recently conducted a study at the Royal Orthopaedic Hospital, Birmingham reviewing risks and complications in patients undergoing similar procedures during the first surge of the pandemic. We found that the prevalence of COVID infection among the patients undergoing these procedures was low at 13% (6 out of 224 patients) among patients treated with arthroplasty procedures between March and May 2020. There were no deaths among patients undergoing elective surgery (1).

3. How can the risks associated with COVID-19 mitigated?

The pathways designed for patients undergoing joint replacement during the current pandemic involve patients having to self-isolate or shielding for a defined period before and after the surgery.  The period of isolation is continuously reviewed. It is important that patients are compliant with the instructions given for their self-isolation or shielding. A member if the team will give you precise information regarding this process.

Patients will also require to be have swab tested prior to surgery to ensure they do not have an infection prior to arrival to the hospital.  

4. Should you get the COVID vaccine before hip or knee replacement surgery?

We have learnt a lot about the SARS-CoV-2 virus over the last year and continue to learn more about the virus, its mutations and the new vaccines. Whilst there is mounting evidence that the COVID vaccine protects patients from getting seriously ill with SARS-CoV-2 infection, it doesn’t protect from getting the infection. It is hence recommended by the Academy of Medical Royal Colleges that patients should try and get vaccinated prior to their procedure. They have advised the Joint Commission for Vaccination and Immunisation that priority is given to patients waiting for surgery and I believe this is currently being considered (2). It is also recommended that there is a period of gap between the immunisation and surgery in case patients are to develop some symptoms or reaction to the vaccine.

5. Can you delay your surgery?

Your surgeon will discuss the options of treatment for your arthritis in the hip or knee. The indications for surgery are significant symptoms – moderate to severe hip pain or knee pain, difficulty with walking and performing activities of daily living, sleep disturbances or progressive change in the shape or the length of the leg. The symptoms when corroborates with the X-rays, undergoing a joint replacement is likely to be successful. Once, a decision is made for suitability for the procedure, patients have the final choice whether they are able to manage their symptoms without surgery or if they would like to proceed with the surgery.  International rollout of vaccine has offered hope but remains impossible to predict how the pandemic is likely to evolve for the coming months. So, you can delay your surgery until a later date if your symptoms are manageable. The risk of developing serious complications with COVID-19 is different for different patient. Your surgeon should be able to guide you.

6. How to manage if you decide to delay your surgery?

There are several recommendations available but here are some of the suggestions from the author-

• Avoiding activities that cause pain
• Take pain medications – paracetamol, codeine, anti-inflammatories (Ibuprofen)
• Pain creams may help in knee pain
• Consider using a walking stick, crutches, or a Zimmer frame
• Applying heat or ice to the affected joint
• Although a steroid injection in the affected joint is an option, and likely to offer pain relief for weeks to months it does carry a small risk of lowering your immunity due to steroids
• Maintain a healthy life style, enrol into a regular self-directed low-impact and stretching exercises
• Maintain a healthy weight and if overweight, use the time to lose weight in preparation for the surgery
• Keep in touch with your surgeon and plan your review
• 7. What are the changes in postoperative rehabilitation due to the pandemic?

This has been another challenging aspect of care during the pandemic and depends on the phase of the pandemic. Thankfully, not all patients have the same therapy needs. Patients undergoing a hip replacement can manage with the therapy they receive in the hospital prior to discharge. They need to continue with them at home and have a contact number to hand if need any further advise. Therapy needs for patients undergoing a knee replacement need more input from the therapist but it is manageable too. Your surgeon and the team will be able to guide you.

Please call Mrs Luan Suckling, secretary to Mr Yuvraj Agrawal for your first appointment on 07515 113815

References

1. Morbidity & mortality in patients undergoing lower limb arthroplasty surgery during the initial surge of the COVID-19 pandemic in the UK at a single-speciality orthopaedic hospital. Agrawal Y, Vasudev A, Sharma A, Cooper G, Stevenson J, Parry M, Dunlop D, Bone and Joint Open, Accepted for publication in January 2021

2. https://www.aomrc.org.uk/statements/covid-19-vaccines-academy-statement/