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Observational Study
. 2022 Jul;37(7):1253-1259.
doi: 10.1016/j.arth.2022.03.049. Epub 2022 Mar 17.

Preoperative Severe Acute Respiratory Syndrome Coronavirus 2 Polymerase Chain Reaction Test at Between 48 and 72 Hours Preoperatively is Safe for Patients Undergoing Primary and Revision Hip and Knee Arthroplasty: A Multicentre International Study

Thomas W Hamilton  1 , Lina H Ingelsrud  2 , Michael Gutman  3 , Alexander D Shearman  1 , Kirill Gromov  2 , Abtin Alvand  1 , Anders Troelsen  2 , Javad Parvizi  3 , Andrew J Price  1
Affiliations
Observational Study

Preoperative Severe Acute Respiratory Syndrome Coronavirus 2 Polymerase Chain Reaction Test at Between 48 and 72 Hours Preoperatively is Safe for Patients Undergoing Primary and Revision Hip and Knee Arthroplasty: A Multicentre International Study

Thomas W Hamilton et al. J Arthroplasty. 2022 Jul.

Abstract

Background: Patients undergoing lower limb arthroplasty who are severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive at the time of surgery have a high risk of mortality. The National Institute for Health and Clinical Care Excellence and the British Orthopaedic Association advise self-isolation for 14 days preoperatively in patients at a high risk of adverse outcomes due to COVID-19. The aim of the study is to assess whether preoperative polymerase chain reaction (PCR) for SARS-CoV-2 could be performed at between 48 and 72 hours preoperatively with specific advice about minimizing the risk of SARS-CoV-2 restricted to between PCR and admission.

Methods: A multicentre, international, observational cohort study of 1,000 lower limb arthroplasty cases was performed. The dual primary outcomes were 30-day conversion to SARS-CoV-2 positive and 30-day SARS-CoV-2 mortality. Secondary outcomes included 30-day SARS-CoV-2 morbidity.

Results: Of the 1,000 cases, 935 (94%) had a PCR between 48 and 72 hours preoperatively. All cases were admitted to and had surgery through a COVID-free pathway. Primary knee arthroplasty was performed in 41% of cases, primary hip arthroplasty in 40%, revision knee arthroplasty in 11%, and revision hip arthroplasty in 9%. Six percent of operations were emergency operations. No cases of SARS-CoV-2 were identified within the first 30 days.

Conclusion: Preoperative SARS-CoV-2 PCR test between 48 and 72 hours preoperatively with advice about minimizing the risk of SARS-CoV-2 restricted to between PCR and admission in conjunction with a COVID-free pathway is safe for patients undergoing primary and revision hip and knee arthroplasty. Preoperative SARS-CoV-2 PCR test alone may be safe but further adequately powered studies are required. This information is important for shared decision making with patients during the current pandemic.

Keywords: COVID-19; SARS-CoV-2; morbidity; mortality; orthopedic surgery; patient outcomes.

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Figures

Fig. 1
Fig. 1
Study flow.
Fig. 2
Fig. 2
Weekly confirmed SARS-CoV-2 cases by country A: UK; B: USA; and C: Denmark. Gray area represents study period at each center [27].
See this image and copyright information in PMC

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