Resuming hip and knee replacements post COVID-19 – What our patients need to know

We are now well aware of the strain the coronavirus has caused globally. It had brought arthroplasty and other elective services to a standstill. Patients are struggling with joint pain and long waiting times.

In this article, expert consultant hip and knee surgeon, Mr Syed Ahmed, sheds some light on how he and his surgical team are navigating safely following the resumption of elective activity in what has soon become the new normal. He will highlight strategies for the pre-operative, peri-operative and post-operative phases.

How has your clinic adapted to protect staff and patients?

As restrictions are being lifted, hand hygiene and wearing face masks when indoors has become mandatory. All staff in clinical areas are aware that if they have any symptoms consistent with COVID-19 they are to go home immediately and quarantine until symptoms resolve.

During its peak, locally, all surgical staff were being tested on a weekly basis, this has now moved to a fortnightly basis, as a prophylactic measure in order to pick up anyone who may well be an asymptomatic carrier.

The clinic areas have also been reconfigured to ensure that waiting rooms are not overcrowded and that patients are able to maintain social distancing whilst waiting. Patients are also being encouraged to wait in their cars and only attend as close to their appointment time as possible.

Are you able to carry out video consultations?

Virtual consultations using several different platforms are becoming increasingly popular. A lot of initial consultations can now be performed using video conferencing technology. However, examining patients in order to confirm the diagnosis and ascertain if they do in fact require surgical intervention often requires a face-to-face consultation.

How do you decide who is safe to undergo elective surgery?

Restarting elective orthopaedics services was only performed after an understanding of the risks involved and the precautions required to overcome these. It is well known that delaying elective hip and knee arthroplasty only has negative consequences on quality of life.

Patients are risk-stratified according to the Royal College of Surgeons and the British Orthopaedic Association (BOA) guidelines by each of the consultants in charge. This allows the surgeon to have a discussion on benefits of surgery versus risks including viral transmission and complications. Some patients who are deemed ‘very high risk’ due to medical co-morbidities may well have their elective surgery delayed for a few months until deemed safe to proceed.

The formation of ‘green pathways’ allows safe delivery of elective arthroplasty surgery. The measures put in place to facilitate this include the following:

• High-risk patients (from risk stratification) have to self-isolate or shield for up to 14 days prior to surgery.
• Test for COVID-19, 72 hours prior to elective surgery and only proceed if negative.
• Both patients and household members are screened for symptoms.
• Social distancing measures to reduce contact at reception, waiting rooms and other communal facilities.
• No visitors during inpatient stays.

General anaesthesia, which requires airway manipulation, endotracheal intubation and positive ventilation, is more predisposed to transmitting SARS-CoV-2. Therefore, patients are predominantly anaesthetised using spinal anaesthesia.

What is recovery like for patients at the moment?

Following arthroplasty surgery, patients will rehabilitate in a ‘green zone’. Enhanced recovery and accelerated discharge will reduce inpatient times and exposure to both other patients and staff. They will be encouraged to continue to shield in order to minimise their risk of contracting COVID-19 postoperatively.

Outpatient access to physiotherapy and occupational therapy will again use similar infection prevention measures. Patients should be encouraged to adopt healthier lifestyles and perform regular exercises in order to speed recovery.

Regulations are constantly being updated and local data is used to guide these protocols. Regions where the local population is adhering to social distancing measures are able to resume normal elective activities quicker.

We need to communicate effectively with our patients in order to ensure that expectations are managed, and they are aware of risks. Hand hygiene and face masks are still the most critical steps to tackle the spread of this virus as we head into the winter months!

Mr Syed Ahmed is a leading hip and knee specialist based in Tunbridge Wells. To make an appointment with him, go and visit his Top Doctors profile. Alternatively, he is available for a video call using our e-Consultation tool, available on his profile.