For patients awaiting a hip or knee replacement, the Covid-19 pandemic has brought unparalleled challenges. Severe arthritis, which is one of the primary reasons for needing joint replacement surgery, is a progressive condition so symptoms gradually worsen. This is exacerbated during periods of immobility and heightened stress so it is reasonable to predict that for many people the pandemic has been particularly difficult.
IMPACT-Restart Collaboration study
A study published in The Bone and Joint Journal by the IMPACT-Restart Collaboration UK looked at the quality of life for patients on the waiting list for total hip replacement and total knee replacement surgery during the pandemic and, in particular, whether length of time on the waiting list had a detrimental impact.
It covered the study period from August to September 2020 and looked at 843 patients from ten centres in the UK. This was compared to a control group of patients from January 2014 to September 2017.
EQ-5D criteria for quality of life
Patients were asked to complete a questionnaire relating to EuroQol five dimension (EQ-5D) criteria, which cover mobility, self-care, usual activities, pain/discomfort and anxiety/depression. The questionnaire also asked for their opinions about undergoing surgery in view of the pandemic and whether they might want to defer their surgery.
“Worse than Death”
In previous research studies, people assigning values to certain health conditions consider some states to be “worse than death”. Researchers for this study determined a (EQ-5D) score of below five to be a health state “worse than death” (WTD). The 2020 study group had significantly worse EQ-5D scores compared to the control group. More than a third of patients waiting for a hip replacement and nearly a quarter waiting for a knee replacement during the pandemic were in a health state “worse than death”. This was almost double that observed in the control group.
Continuing challenge for patients
Under normal circumstances, patients with the worst quality of life and the most challenging symptoms are expedited for joint replacement surgery, however this was not possible during Covid. Even as surgery resumes, it is likely that patients who have the lowest surgical risk will be prioritised, leading to further delays for those with the worst quality of life. This situation is extremely difficult for patients affected.
Deteriorating quality of life
Over 80% of patients in the 2020 survey said their quality of life had deteriorated while they were waiting and each additional month on the waiting list was associated with a further drop.
Don’t defer surgery
One hundred and seventeen patients in the survey said they wanted to defer their surgery, the main reason cited as being health concerns – their own or those of their family.
If you are awaiting joint replacement surgery, our advice as orthopaedic surgeons is not to defer your surgery as continuing delays will lead to a further deterioration in your quality of life and a worsening of your condition.
All hospitals, including Beacon Hospital and Sports Surgery Clinic where Joseph Queally practices, have robust protocols in place to keep patients safe. This includes an in-house Infection Prevention Control team who follow strict HSE guidelines. Prior to going into hospital all patients has their temperature taken and are required to complete an online Covid assessment questionnaire. Everyone is asked to sanitise their hands. Social distancing measures are in place throughout the hospital and everyone needs to wear a face covering. Enhanced cleaning schedules are in place, paying particular attention to frequently touched areas and all staff wear the correct PPE. All patients attending for surgery are required to have a Covid test prior to admission.
The message from Beacon is that all departments are open and it is important not to put off important healthcare appointments. If you are concerned about undergoing joint replacement surgery or would like to discuss your condition, contact us for advice.