SARS-CoV-2 test in conjunction with COVID-free pathway may be safe prior to TJA
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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.
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.”
Perspective
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The article by Thomas W. Hamilton, MD, DPhil, and colleagues is an interesting method for addressing the delays related to elective arthroplasty surgery during the COVID-19 pandemic. During the pandemic, some patients have been hesitant to move forward with elective surgery due to concerns with risk of contracting COVID-19 while being inpatient. Medical providers have been concerned with the risk of spreading COVID-19 between health care personnel or among inpatients when performing surgery on patients that may be infected but asymptomatic. This article provides evidence that a PCR test 48 to 72 hours effectively prevented elective surgery on a patient that could have either symptomatic or asymptomatic COVID-19. By screening these patients preoperatively, there was no spread of disease among hospital workers or patients within the hospital. Furthermore, no patients suffered from COVID-19 infection postoperatively that could have hindered their recovery from elective surgery.
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