Rizkalla James M, Gladnick Brian P, Bhimani Aamir A, Wood Dorian S, Kitziger Kurt J, Peters Paul C
Department of Orthopaedic Surgery, Baylor University Medical Center, 3500 Gaston Ave., Dallas, TX, 75246, USA.
Adult Hip and Knee Reconstruction, W.B. Carrell Memorial Clinic, 9301 N. Central Expressway, Suite 500, Dallas, TX, 75231, USA.
Curr Rev Musculoskelet Med. 2020 Aug;13(4):416-424. doi: 10.1007/s12178-020-09642-y.
The purpose of this review was to evaluate the available literature to determine what may be considered urgent indications for total hip arthroplasty, in the unprecedented setting of the worldwide COVID-19 pandemic.
SARS-CoV-2 is a novel coronavirus currently presenting in the form of a global pandemic, referred to as COVID-19. In this setting, multiple states have issued executive orders prohibiting "elective" surgery, including arthroplasty, in order to preserve healthcare resources. However, during this unprecedented reduction in elective surgery, there is likely to be some controversy as to what constitutes a purely "elective" procedure, versus an "urgent" procedure, particularly regarding hip arthroplasty. We reviewed the available literature for articles discussing the most commonly encountered indications for primary, conversion, and revision hip arthroplasty. Based upon the indications discussed in these articles, we further stratified these indications into "elective" versus "urgent" categories. In patients presenting with hip arthroplasty indications, the decision to proceed urgently with surgery should be based upon (a) the potential harm incurred by the patient if the surgery was delayed and (b) the potential risk incurred by the patient in the context of COVID-19 if surgery was performed. The authors present a decision-making algorithm for determining surgical urgency in three patients who underwent surgery in this context. Urgent total hip arthroplasty in the setting of the COVID-19 pandemic is a complex decision-making process, involving clinical and epidemiological factors. These decisions are best made in coordination with a multidisciplinary committee of one's peers. Region-specific issues such as hospital resources and availability of PPE may also inform the decision-making process.
本综述的目的是评估现有文献，以确定在全球新冠疫情这一前所未有的背景下，全髋关节置换术的哪些情况可被视为紧急指征。
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）是一种新型冠状病毒，目前以全球大流行的形式出现，即2019冠状病毒病（COVID-19）。在这种情况下，多个州已发布行政命令，禁止包括关节置换术在内的“择期”手术，以保护医疗资源。然而，在择期手术前所未有的减少期间，对于什么构成纯粹的“择期”手术与“紧急”手术，尤其是关于髋关节置换术，可能会存在一些争议。我们查阅了现有文献，寻找讨论初次、转换和翻修髋关节置换术最常见指征的文章。根据这些文章中讨论的指征，我们进一步将这些指征分为“择期”和“紧急”两类。对于有髋关节置换术指征的患者，紧急进行手术的决定应基于：（a）如果手术延迟患者可能遭受的潜在损害，以及（b）如果进行手术患者在新冠疫情背景下可能面临的潜在风险。作者提出了一种决策算法，用于确定在此背景下接受手术的三名患者的手术紧迫性。在新冠疫情背景下进行紧急全髋关节置换术是一个复杂的决策过程，涉及临床和流行病学因素。这些决策最好与同行的多学科委员会协调做出。特定地区的问题，如医院资源和个人防护装备的可用性，也可能为决策过程提供参考。
