Impact of the COVID-19 lockdown on patient-reported outcome measures in Dutch hip and knee arthroplasty patients

Joshua M. Bonsel, Lichelle Groot, Abigael Cohen, Jan A.N. Verhaar, Maaike G.J. Gademan, Anneke Spekenbrink-Spooren, Gouke J. Bonsel*, Max Reijman

*Corresponding author for this work

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Abstract

Background and purpose — 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. Patients and methods — We performed cross-sec-tional 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. Results — 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). Interpretation — During the COVID-19 lockdown, THA patients had slightly worse preoperative PROMs, suggest-ing 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.

Original languageEnglish
Pages (from-to)808-818
Number of pages11
JournalActa Orthopaedica
Volume93
DOIs
Publication statusPublished - 14 Oct 2022

Bibliographical note

Funding Information:
tocol for legally conforming data access, therefore no ethical approval additional to LROI permission was required. One of the authors (JB) has received funding from EuroQol for a PhD project including this study. The views expressed by the authors in this manuscript do not necessarily reflect the views of the EuroQol group.

Publisher Copyright:
© 2022 The Author(s). Published by Medical Journals Sweden, on behalf of the Nordic Orthopedic Federation.

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