Orthopaedic Surgery and Traumatology Department, Knee Unit, Hospital La Paz, Universidad Autónoma de Madrid, Pº Castellana 261, 28046, Madrid, Spain.
Knee Surg Sports Traumatol Arthrosc. 2022 Aug;30(8):2723-2730. doi: 10.1007/s00167-021-06611-x. Epub 2021 May 20.
To identify factors influencing patient's availability to re-schedule primary total knee replacement (TKR) or revision (RKR) surgery after the lockdown (March-May 2020) during the COVID-19 pandemic.
A prospective cohort study through a telephone survey was performed in 156 patients (143 for primary and 13 for revision) included in the TKR and RKR surgical waiting list before March 2020. Contact of each patient with COVID-19, stress and anxiety, perceived pain, and function were obtained in the interviews, and also the preference of each patient to have re-scheduled surgery (early or late). Finally, we registered their response (acceptance or refusal) when surgery was effectively re-scheduled.
88 out of 156 patients waiting for knee replacement (76/143 of those waiting for TKR, 12/13 of those waiting for RKR) declared themselves ready for surgery in less than 1 month. When re-scheduled, 115 patients underwent surgery and 41 refused. Significantly different preferences were found for age (more prone to surgery if under 65), revision surgery (more readily available), pain (7.9 ± 1.7/10 in NRS in those undergoing surgery, 5.6 ± 2.3/10 in those refusing, p = 0.000), or COVID-19 diagnosis, but not other close contact with COVID-19, comorbidities, stress, or anxiety. A logistic regression model confirmed that revision surgery (OR 9.33), perceived severe pain (OR 5.21), and age under 65 years (OR 5.82) were significantly associated with patient preference. The probability of patients over 65 to prefer early surgery reached 60% only with pain at or above 9/10.
Surgical timing preferences for knee replacement vary between patients older than 65 years (immediate surgery only when pain is intense) and younger patients (immediate surgery no matter the amount of pain). Even if COVID-19 severely stroke our population, the need for knee replacement stood in the young population and even in the aged population at risk for COVID when pain was important.
在 COVID-19 大流行期间，确定封锁（2020 年 3 月至 5 月）后影响患者重新安排初次全膝关节置换术（TKR）或翻修术（RKR）手术的因素。
通过电话调查对 156 名患者（143 名初次 TKR，13 名 RKR）进行前瞻性队列研究，这些患者均在 2020 年 3 月前列入 TKR 和 RKR 手术等候名单。在访谈中获取每位患者与 COVID-19 的接触、压力和焦虑、感知疼痛和功能的情况，还获取每位患者对重新安排手术（早期或晚期）的偏好。最后，我们记录了手术实际重新安排时每位患者的反应（接受或拒绝）。
在等待膝关节置换的 156 名患者中，有 88 名（143 名 TKR 中有 76 名，13 名 RKR 中有 12 名）表示愿意在不到 1 个月的时间内接受手术。当重新安排手术时，有 115 名患者接受了手术，有 41 名患者拒绝了手术。在年龄（65 岁以下更倾向于手术）、翻修手术（更愿意接受）、疼痛（手术组 NRS 评分 7.9±1.7/10，拒绝组 5.6±2.3/10，p=0.000）或 COVID-19 诊断方面发现了明显不同的偏好，但与其他密切接触 COVID-19、合并症、压力或焦虑无关。逻辑回归模型证实，翻修手术（OR 9.33）、严重疼痛感知（OR 5.21）和 65 岁以下年龄（OR 5.82）与患者偏好显著相关。只有疼痛达到或高于 9/10 时，65 岁以上患者才更倾向于早期手术。
膝关节置换术的手术时机偏好因 65 岁以上患者（只有疼痛剧烈时才进行立即手术）和年轻患者（无论疼痛程度如何，都进行立即手术）而异。即使 COVID-19 对我们的人群造成了严重打击，对于疼痛严重的年轻人群和有 COVID 风险的老年人群来说，对膝关节置换的需求仍然存在。
