Triaging Total Hip Arthroplasty During the COVID-19 Pandemic

Abstract

Purpose of review: The purpose of this review was to evaluate the available literature to determine what may be considered urgent indications for total hip arthroplasty, in the unprecedented setting of the worldwide COVID-19 pandemic.

Recent findings: SARS-CoV-2 is a novel coronavirus currently presenting in the form of a global pandemic, referred to as COVID-19. In this setting, multiple states have issued executive orders prohibiting "elective" surgery, including arthroplasty, in order to preserve healthcare resources. However, during this unprecedented reduction in elective surgery, there is likely to be some controversy as to what constitutes a purely "elective" procedure, versus an "urgent" procedure, particularly regarding hip arthroplasty. We reviewed the available literature for articles discussing the most commonly encountered indications for primary, conversion, and revision hip arthroplasty. Based upon the indications discussed in these articles, we further stratified these indications into "elective" versus "urgent" categories. In patients presenting with hip arthroplasty indications, the decision to proceed urgently with surgery should be based upon (a) the potential harm incurred by the patient if the surgery was delayed and (b) the potential risk incurred by the patient in the context of COVID-19 if surgery was performed. The authors present a decision-making algorithm for determining surgical urgency in three patients who underwent surgery in this context. Urgent total hip arthroplasty in the setting of the COVID-19 pandemic is a complex decision-making process, involving clinical and epidemiological factors. These decisions are best made in coordination with a multidisciplinary committee of one's peers. Region-specific issues such as hospital resources and availability of PPE may also inform the decision-making process.

Keywords: COVID-19; Coronavirus; Elective; Hip arthroplasty; Pandemic; Urgent.

Fig. 1

Decision-making algorithm for determining urgency of hip arthroplasty surgery during the COVID-19 pandemic

Fig. 2

Sequential left hip radiographs demonstrating interval progression of AVN, with collapse of the articulating surface of the femoral head. The collapsed femoral head is now eroding superolaterally through the acetabulum, creating a superolateral rim defect

Fig. 3

Anteroposterior pelvis radiograph demonstrating percutaneous cannulated screw fixation of a valgus-impacted femoral neck fracture. The fracture construct is seen to have collapsed into nonunion, with a persistently visible fracture line and shortening of the femoral neck, with resulting partial backing-out of the screws laterally