Hip replacement surgery in the COVID-19 pandemic

While pandemic restrictions have been, and are due to be completely, loosened, unfortunately experts believe the COVID-19 pandemic will remain part of our everyday lives for some time.

Experienced consultant trauma and orthopaedic surgeon, Mr Daniel Phillip Thomas speaks to Top Doctors to reassure people that are considering having a hip replacement procedure at the moment, providing information about the safety measures that have been introduced and why it might not be a good idea to delay hip replacement surgery despite the situation. 

How has COVID affected hip replacement surgery availability?

In Wales, after the first lockdown all elective joint replacement stopped. It recommenced in the private sector at Nuffield Hospital in July 2020 once the hospital was established as a ‘Green Zone’. This meant that all patients had to be swabbed prior to admission and a strict period of self-isolation was mandatory.

The private sector has continued with joint replacement surgery without any issues. The NHS did restart in a limited capacity in November 2020 but stopped again due to staff redeployment.

Who will be the priority on the hip replacement list as health services return to normal?

At the present time, we are still waiting for our normal staff to be brought back into elective services. We, as a group of surgeons, have been trying to prioritise the patients with the most severe disease and the lowest risk profile to be operated on as soon as possible. This has been done by looking through patient records, X-rays and speaking to patients, virtually and in person, in the outpatient department.

Is it safe to have a hip replacement during the COVID-19 pandemic?

I would say that it is reasonably safe, particularly if the hospital is what is termed as a 'Green Zone'. This means that all patients are screened prior to coming into hospital and by now, all the staff have been vaccinated. It is sensible to try and avoid hip replacement on high-risk individuals. The highest risk are elderly males (over the age of 80) combined with comorbidities such as diabetes, heart disease and obesity. There's also known to be a higher risk in the BAME ethic groups.

Should people put off elective joint surgery because of the pandemic?

I suspect the pandemic is going to linger on for many months, if not years. Therefore, I would weigh up the pros and cons of delaying hip surgery. If the hip joint is not very intrusive in terms of activities in their daily life and the patient is not deteriorating significantly, then it would be reasonable to wait. If they are, however, struggling to manage with day-to-day tasks and are in a lower-risk category then I would advise with getting on with operation.

What are the consequences of delaying hip replacement surgery?

There can be an adverse effect on the outcome of the surgery if patients wait too long. Particular concerns would be significant muscle wasting (this commonly affects the quadriceps muscle group at the front on the thigh and the gluteal muscles around the buttock area). A deteriorating range of movement and leg shortening would be significant problems that could affect the eventual outcome. Most patients, however, have an excellent outcome after this surgery in terms of pain relief and improved function.

Is getting a hip replacement fastest in the private health sector?

There is no doubt that, even in normal times without a pandemic, the private sector is a quicker route to surgery. At the present time it is the only route to having surgery. This will hopefully change in the near future but it will still be far quicker, with the amount of catching up that it is to be done in the NHS, to have this in the private healthcare sector.