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

doi:10.2340/17453674.2022.4856

Authors

Joshua M Bonsel Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, University Medical Center Rotterdam
Lichelle Groot Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, University Medical Center Rotterdam; Department of Orthopaedics, Leiden University Medical Center
Abigael Cohen Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, University Medical Center Rotterdam https://orcid.org/0000-0001-9412-1134
Jan A N Verhaar Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, University Medical Center Rotterdam https://orcid.org/0000-0003-3016-9600
Maaike G J Gademan Department of Orthopaedics, Leiden University Medical Center; Department of Clinical Epidemiology, Leiden University Medical Center https://orcid.org/0000-0002-6106-3385
Anneke Spekenbrink-Spooren Dutch Orthopaedic Registry (Landelijke Registratie Orthopedische Interventies [LROI])
Gouke J Bonsel Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, The Netherlands https://orcid.org/0000-0002-8364-1086
Max Reijman Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, University Medical Center Rotterdam https://orcid.org/0000-0001-6316-9629

DOI:

https://doi.org/10.2340/17453674.2022.4856

Keywords:

COVID-19, Dutch Orthopedic Registry (LROI), Hip, Knee, Patient-reported outcome measures, Quality of Life

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-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.
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, 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.