Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, University Medical Center Rotterdam.
Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, University Medical Center Rotterdam; Department of Orthopaedics, Leiden University Medical Center.
Acta Orthop. 2022 Oct 14;93:808-818. doi: 10.2340/17453674.2022.4856.
During the first COVID-19 lockdown elective surgery was greatly reduced. Prioritization of patients with greater need and expected benefit in terms of quality of life was advised. The lockdown also potentially affected follow-up outcomes. Therefore, our study compared patient-reported outcome measures (PROMs) retrieved during the lockdown of Dutch primary total hip and knee arthroplasty (THA, TKA) patients with previous years.
We performed cross-sectional analyses using national data from the Dutch Orthopaedic Registry (LROI). All primary elective THA and TKA patients with preoperative or postoperative PROMs (EQ-5D-3L index, OHS/OKS) during the first COVID-19 lockdown between March and July 15, 2020 were included. Patients with PROMs during the same months in 2018 plus 2019 were used as control. Finally, 33,453 THA and 27,335 TKA patients were included. Patient characteristics were compared during versus before the lockdown. Subsequently, the lockdown effect on PROMs scores was analyzed with multivariable linear regression.
During the COVID-19 lockdown, THA and TKA patients had a lower age and BMI preoperatively, and more often had surgery in private clinics. Both preoperative PROMs in THA patients, but not in TKA patients, were worse (EQ-5D: Adjusted mean difference (AMD) -0.021, p < 0.001) during the lockdown compared with prior years. Both postoperative PROMs in THA and TKA patients were better during the lockdown (12-month EQ-5D in THA: AMD 0.010, p = 0.003; and in TKA: AMD 0.013, p < 0.001).
During the COVID-19 lockdown, THA patients had slightly worse preoperative PROMs, suggesting selection of patients with greater urgency. Postoperative PROMs in both THA and TKA patients differed minimally. Overall, the observed differences were likely not clinically relevant.
在第一次 COVID-19 封锁期间，择期手术大大减少。建议优先考虑那些有更大需求且预期生活质量获益更大的患者。封锁也可能影响随访结果。因此，我们的研究比较了荷兰初次全髋关节和膝关节置换术（THA、TKA）患者在封锁期间与前几年的患者报告结局测量（PROMs）。
我们使用荷兰骨科登记处（LROI）的全国数据进行了横断面分析。所有在 2020 年 3 月至 7 月 15 日第一次 COVID-19 封锁期间有术前或术后 PROMs（EQ-5D-3L 指数、OHS/OKS）的初次择期 THA 和 TKA 患者均纳入研究。将在同一月份有 PROMs 的 2018 年和 2019 年的患者作为对照。最终，共纳入 33453 例 THA 和 27335 例 TKA 患者。比较了封锁期间与之前患者的特征。随后，使用多变量线性回归分析封锁对 PROMs 评分的影响。
在 COVID-19 封锁期间，THA 和 TKA 患者术前年龄和 BMI 较低，且更多地在私人诊所接受手术。THA 患者的术前 PROMs 均较差（EQ-5D：调整平均差值（AMD）-0.021，p < 0.001），而 TKA 患者的术前 PROMs 无显著差异。THA 和 TKA 患者的术后 PROMs 在封锁期间均有所改善（THA 患者的 12 个月 EQ-5D：AMD 0.010，p = 0.003；TKA 患者：AMD 0.013，p < 0.001）。
在 COVID-19 封锁期间，THA 患者的术前 PROMs 略有下降，表明选择了更紧急的患者。THA 和 TKA 患者的术后 PROMs 差异极小。总体而言，观察到的差异可能无临床意义。
