Published results showed a preoperative polymerase chain reaction test with advice about minimizing the risk of SARS-CoV-2 in conjunction with a COVID-free pathway may be safe for patients undergoing hip and knee arthroplasty.
“The incidence of COVID-19 within our communities remains high but this study has demonstrated that, through well-designed clinical pathways, we can minimize the risk that it presents to patients,” Thomas W. Hamilton, MD, DPhil, National Institute for Health and Care Research Academic Clinical Lecturer in orthopedic surgery at the University of Oxford, told Healio.
Hamilton and colleagues performed a multicenter, international, observational cohort study of 1,000 patients who underwent primary or revision THA or TKA on COVID-free pathways following a negative polymerase chain reaction (PCR) test for SARS-CoV-2 between April 27, 2020, and Nov. 10, 2020. Patients undergoing planned total joint arthroplasty had a PCR test performed between 48 and 72 hours prior to admission and were advised to modify their behavior to reduce the risk of SARS-CoV-2 infection, while patients undergoing emergency TJA required a negative PCR test prior to admission but did not complete a period of behavioral modification due to the nature of their presentation, according to researchers.
Thomas W. Hamilton
Researchers considered 30-day conversion to SARS-CoV-2 positive- and 30-day SARS-CoV-2-related mortality as dual primary outcomes, and secondary outcomes included 30-day SARS-CoV-2-related morbidity, including pneumonia, acute respiratory distress syndrome or unexpected postoperative ventilation.
Overall, 94% of the 1,000 cases had a PCR test between 48 and 72 hours preoperatively, and all cases were admitted to and had surgery through a COVID-free pathway. Researchers found 41% of patients underwent primary knee arthroplasty, 40% underwent primary hip arthroplasty, 11% underwent revision knee arthroplasty and 9% underwent revision hip arthroplasty. Researchers also noted emergency operations made up 6% of operations. Within the first 30 days, no cases of SARS-CoV-2 were identified, according to results.
“The results of this study are important and inform the shared decision process when deciding whether to undergo primary or revision hip or knee arthroplasty,” Hamilton said. “The challenges that COVID-19 presents continue to evolve, and we must maintain an evidence-based approach.”