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Joint Replacement in Covid

Will there be a Paradigm Shift in Joint Replacement during COVID 19 Pandemic?

Covid 19 Pandemic has set a New Norm for every speciality in Medicine. No one has thought that complete philosophy toward life will change so suddenly. There is no doubt that fear from such a dreaded infection has scared everyone to think with sense of security to come out openly and of course think 10 times to undergo any planed surgical procedure specially for degenerative disorder like osteoarthritis of knee and hip.

Generally, patient who comes for joint replacement are above 50 to 60 years of age and usually they have one or other co-morbid condition associated with them. Having said this Covid 19 Pandemic has not changed any disease pattern of cold orthopaedics. Number of patients suffering from painful joint disease in advance stage will remain the same. There is an anxiety and fear factors in the mind of these patients who need joint replacement in current scenario. We predict number of patients coming post covid would be in large number due to this reason.

There are many questions to be answered for patients awaiting joint replacement. First and foremost is – is it safe to get operated in this time? Answer is, yes.We do realise that any patient who need joint replacement has psychological pressure of being exposed to Covid19. Because there are very strict smart protocol in our hospital for safety measures with current norms and there is complete segregation of non-covid and covid patients, wards & operation theatres. We take all necessary precautions to take care of patient and all healthcare workers in the hospital. We assure all our patients along with their family members that till today in this pandemic we have operated many patients with all safety measures and none of them became positive for Covid. On the contrary we had even 80 years old patient with Covid infection 2 months prior to fracture of hip ball who was operated with excellent result and satisfaction. Any patient who requires a planned surgery post Covid infection has to wait for at least 8 weeks.

Current vaccination situation definitely provide assurance of preventing serious illness. Vaccination is not the contraindication for knee or hip replacement surgery and vaccination can be done at any time, means prior or after to joint replacement surgery.

So there will be a paradigm shift in joint replacement surgery during and after Covid Pandemic in term of safety measures with complete assurance from healthcare system to provide the best possible management and excellent results. There is no need to worry with anxiety and fear with current situation as we are getting better day by day with these New Norms. Knee and Hip replacement surgeries are being performed with at most care and safety to all concern in Dr L H Hiranandani Hospital.

Covid 19 safety protocol for patients undergoing Joint Replacement Surgery

Covid-19 is a severely contagious disease presented with repeated spikes in epidemic waves across the world. Sudden emergence of disease affected patient care among patients suffering with other medical conditions, chronic joint pains being one of them. Patients suffering with joint pains are mostly elderly people with underlying medical co-morbidities like obesity, diabetes mellitus, hypertension, underlying renal/cardiac/ pulmonary dysfunction, etc. These subset of people are more prone to contract Covid-19 infection and subsequent morbidities associated with it.

Joint pain due to underlying degenerative or inflammatory arthritis are usually managed non-operatively initially. A stage comes when these modalities don’t work any longer and patients tend to become bed ridden and analgesic/opioid dependent. Uncontrolled pain, which is the most important reason for undergoing joint replacement surgery, can cause sleep disturbance, depression, state of hopelessness. These patients opt for joint replacement surgery so that they can get their “life back” and be “independently mobile”.

Executive orders on postponing elective surgeries, Covid care norms and fear among the elderly population led to decreased number of elective joint replacements being performed during the pandemic. The patients with advanced arthritis have greater risk of worsening if surgery is delayed. Also, delaying the surgery can worsen outcome of the surgery in these patients with advance joint diseases.

In such an extraordinary situation, Dr LH Hiranandani Hospital took a lead to provide meticulously designed Covid-19 appropriate surgicalcare protocol for these patients. A care pathway was formulated as per the Covid-19 guidelines for these patient who required joint replacement surgery. This pathway started before the time of admission till patient got discharged from the hospital. Meticulous care was taken since the time of performing RT PCR prior to admission. After admission, these patients were admitted separately in non-Covid designated area. During surgery, precautions as per the Covid protocols,were taken to protect patient as well as healthcare professionals from accidently contracting any infection. Surgical protocol and surgical care pathway was maintained as pre-Covid time. Intermingling of healthcare professionals between Covid and non- Covid areas were strictly restricted.

Covid 19 is going to stay longer, we may not know for how long. At the same time these patients with advanced arthritic joints need to live normal, independent and purposeful life. As a healthcare professional, it is our collective duty and responsibility to provide safe environment for their non-Covid surgical /medical care. Extra-ordinary situations requires extra-ordinary measures and as a responsible members of society, we at Dr LH Hiranandani Hospital, stand shoulder to shoulder with these elderly patients and strive continuously to improve their quality of life with best of our available resources.