BASK, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, Holborn, London WC2A 3PE, United Kingdom.
BASK, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, Holborn, London WC2A 3PE, United Kingdom.
Knee. 2021 Jan;28:57-63. doi: 10.1016/j.knee.2020.10.011. Epub 2020 Dec 8.
Elective orthopaedic surgery during the Covid-19 pandemic requires careful case prioritisation. We aimed to produce consensus-based guidelines on the prioritisation of revision total knee arthroplasty (TKA) procedures.
Twenty-three revision TKA scenarios were assigned priority (NHS England/Royal College of Surgeons scale) by the British Association for Surgery of the Knee (BASK) Revision Knee Working Group (n = 24). Consensus agreement was defined as ≥70% respondents (18/24) giving the same prioritisation. Two voting rounds were undertaken; procedures achieving <70% agreement were given their most commonly assigned priority.
18/23 procedures achieved ≥70% agreement. Three were P1a (surgery within <24 h); DAIR for sepsis, peri-prosthetic fracture (PPF) fixation and PPF-revision TKA. Three were P1b (<72 h); debridement, antibiotics and implant retention (DAIR) for a stable patient, flap coverage for an open knee, and acute extensor mechanism rupture. Eight were P2 (<4 weeks), including aseptic loosening at risk of collapse, inter-stage patients with poor functioning spacers. Five were P3 (<3 months), including second stage revision for infection, revision for instability with limited mobility. Four were P4 (can wait >3 months) e.g. aseptic loosening.
Sepsis and PPF surgery are the most urgent procedures. Although most procedures should be undertaken within one to three months (P2/3), these cases represent a small revision practice volume; P4 cases (e.g. aseptic loosening without risk of collapse) make up most surgeons' caseload. These recommendations are a guideline; patient co-morbidities, Covid-19 pathways, availability of support services and multi-disciplinary team discussion within the regional revision network will dictate prioritisation.
在新冠疫情期间，择期骨科手术需要仔细进行病例优先级排序。我们旨在制定基于共识的修订全膝关节置换术（TKA）手术优先级排序指南。
英国膝关节外科协会（BASK）修订膝关节工作组（n=24）对 23 例修订 TKA 情况进行了优先级排序（NHS England/Royal College of Surgeons 分级）。一致性协议定义为≥70%的受访者（24 人中的 18 人）给予相同的优先级排序。进行了两轮投票；未达到≥70%一致意见的手术采用最常分配的优先级。
18/23 例手术达到≥70%的一致意见。其中 3 例为 P1a（<24 小时内手术）：脓毒症、假体周围骨折（PPF）固定和 PPF 翻修 TKA 的清创、冲洗和引流（DAIR）。3 例为 P1b（<72 小时内）：稳定患者的清创、抗生素和保留植入物（DAIR）、膝关节开放的皮瓣覆盖、急性伸肌机制破裂。8 例为 P2（<4 周），包括有塌陷风险的无菌性松动、间隔期功能不佳的 spacer 患者。5 例为 P3（<3 个月），包括感染的二期翻修、活动度有限的不稳定翻修。4 例为 P4（>3 个月可等待），如无菌性松动。
脓毒症和 PPF 手术是最紧急的手术。尽管大多数手术应在 1 至 3 个月内进行（P2/3），但这些病例仅占小部分修订手术量；P4 病例（如无塌陷风险的无菌性松动）构成了大多数外科医生的病例量。这些建议是指南；患者合并症、新冠疫情路径、支持服务的可用性以及区域修订网络内的多学科团队讨论将决定优先级。
