COVID-19 and the Resumption of Joint Replacement Surgery

Jun 7, 2020

The ongoing presence of COVID-19 has raised some concerns about the safety of joint replacement surgery relative to the risk of COVID exposure and transmission. Because the sickest COVID patients are admitted to the hospital for care, hospitals necessarily become receptacles for disease. While some epidemiological data would suggest that the number of hospitalizations and deaths from COVID has past its peak, other information suggests that the virus is still present, and its transmission is still a public health risk. The reopening of the economy, which was originally intended to follow guidelines based on declining COVID cases, seems to be proceeding despite some evidence that we continue on a relative plateau of new cases that has not equated to the “flattening of the curve” that was originally forcast. This would suggest that our threshold for resuming “business as usual” is not directly linked to scientific guidelines rather to the public’s desire to move forward from the lockdown.

Within this uncertainty, elective joint replacement has resumed over the past month, and we have seen a gradual lifting of criteria for who is safe to undergo surgery. This phasing back in of surgery has been based on progressive experience that with proper precautions and screening, there does not appear to be an increased risk of COVID contraction by undergoing surgery. Concomitant with this resumption of care is also a greater interest in the transition of cases to the outpatient environment to avoid an inpatient hospital stay. As Medicare has now approved total knee replacements to be performed in ambulatory surgery centers, we are likely to see a shift in these cases to these outpatient centers for patients who are eligible for outpatient care.

Outpatient joint replacement has proven safe and effective in multiple studies provided that patients meet criteria to go home the same day. These include relative good health, relative independence with mobility, a safe living environment and a caregiver that can be present for the first several days. Outpatient joint replacement also requires experience by the care team performing the surgery to include adequate pain management pathways, robust patient education, access to the care team and skilled surgery.

Our practice has been performing outpatient joint replacement for over 4 years, and we have successfully now done over 1500 same-day hip, knee and shoulder replacements. This collective experience is foremost in the region. Our AVATAR rapid recovery, customized care program enables safe outpatient joint replacement with a low complications rate, a high level of patient satisfaction and a commitment to outcomes by our care team. As this pandemic continues to reshape the way care is delivered, our expertise provides a foundation by which we can safely return to surgery, limiting the risk of exposure to sick patients. We believe in the merits of outpatient joint replacement surgery, and our patients are a testimonial to the benefits of this approach.