Patients Waiting for Hip and Knee Surgery “Disproportionately” Affected by COVID-Related Delays

The question: My knee replacement surgery was postponed due to the COVID-19 pandemic. I’m not sure when it will be rescheduled. Knee pain is exciting. What should I do in the meantime?

The answer: Surely you are not alone. Many elective (or non-emergency) procedures were suspended when hospitals cleaned the decks to make way for COVID-19 patients during the various waves of the pandemic.

And patients waiting for knee and hip surgery were disproportionately affected by these delays, according to Dr. Mohit Bhandari, president of the Canadian Orthopedic Association.

Knee and hip replacement cases tend to differ because “they were perceived as lifestyle surgeries, which is the furthest from the truth,” says Dr. Bhandari. “These are restorative surgeries to weaken conditions.”

“This unfortunate lifestyle brand has given priority to some of these patients who are really in agony.”

Prior to the pandemic, the waiting time for knee and hip surgeries ranged from six to twelve months. This wait will now be substantially longer until the pending cases are cleared, Dr. Bhandari says.

Orthopedic surgeons are concerned that their patients will continue to deteriorate during the delay.

It’s vitally important that patients who need a knee or hip replacement stay physically active, says Dr. Vickas Khanna, an orthopedic surgeon and assistant professor at McMaster University in Hamilton.

A targeted exercise program strengthens the muscles that support the knee or hip and can reduce pain. In addition, exercise helps maintain a healthy weight, so there is less pressure on troubled joints.

However, Dr. Khanna easily acknowledges, “It’s hard to tell patients to exercise when they can barely move a knee or hip.”

In these cases, doctors may suggest various treatments to relieve the discomfort.

“Each option has advantages and disadvantages,” explains Dr. Khanna, adding that they can only provide “minimal benefit in people with severe degenerative changes in the joints.”

Therapies include:

• An injection of cortisone into the joint can reduce inflammation and stiffness for four to eight weeks. But cortisone should be used judiciously. Research suggests that repeated shots can accelerate the deterioration of cartilage, the shock-absorbing material between bones.
• An injection of hyaluronic acid works for about six months. It is a synthetic material that mimics the natural lubricating fluid found inside healthy joints. Unlike cortisone, hyaluronic acid is not associated with cartilage degradation. But the cost is not covered by most provincial health systems. Some private insurance plans will pick up the tab. Patients without this coverage will pay about $ 500 out of pocket for treatment.
• Platelet-rich plasma or PRP is said to potentiate the body’s own healing powers and can relieve pain and inflammation for six to 12 months. The blood is drawn from the patient and placed in a centrifuge. The machine rotates the blood, separating it into different parts. Some of the components, such as platelets and growth factors, are used to produce PRP, which is then injected into the sore joint. Sometimes, several injections are given over several weeks. Each injection costs between $ 500 and $ 700.

Dr. Moin Khan, an orthopedic surgeon and assistant professor at McMaster University, says the effectiveness of injections, especially in the case of PRP, can vary from patient to patient. “There are different commercial PRP formulations on the market,” he says, adding that there is a lack of high-quality comparative studies that show which is the best.

There is no doubt that the expense of some of these specialized therapies will put them out of the reach of many people.

Still, “there are a lot of things people can do on their own to maintain muscle strength,” says Dr. Jihad Abouali, an orthopedic surgeon and assistant professor at the University of Toronto.

He notes that the Canadian Arthritis Society website provides information on home exercises for knees and hips.

And, for pain control, doctors often suggest topical painkillers because prolonged use of nonsteroidal anti-inflammatory pills can cause stomach problems.

Despite their best efforts to stay fit, some patients will “get worse while on a waiting list,” says Dr. Bhandari. He believes every effort should be made to provide them with “restorative” surgery. “Pain patients can’t wait.”