The Effect of the COVID-19 Orthopaedic Joint Surgery "Restart" on Patient Outcomes in Michigan.

Background: The COVID-19 pandemic significantly decreased elective total joint arthroplasty volume in Michigan. Depending on local ordinances, elective procedures were completely shut down for periods. We hypothesized that decreased volume and surgical gaps would impact outcomes once procedures restarted. This study compared outcomes of total hip and knee arthroplasty (TJA) following the COVID-19 pandemic restart. Methods: This study utilized the Michigan Arthroplasty Registry Collaborative Quality Initiative database to analyze outcomes for TJA compared to the previous uninterrupted year to investigate the effects of the pandemic on TJA outcomes. Results: As expected, there was a significant reduction in surgical volume for both total hip arthroplasty and total knee arthroplasty during the initial surge of COVID-19 cases in Michigan. There was a significant increasing shift toward performing TJA at ambulatory surgery centers and hospital outpatient departments. There was a significantly higher discharge home with use of home care services for both hips and knees. There was a slightly elevated rate of deep vein thrombosis among TJA patients within the early fall of 2020, which normalized to prepandemic levels by the fall. No other significant differences were noted. Conclusions: Overall, outcomes were similar after the resumption of TJA following the COVID-19 pandemic. Perhaps this is a test of the overall training of orthopaedic surgeons performing total hip arthroplasty/total knee arthroplasty and the application of well-established pathways. The pandemic likely promulgated the ongoing move for site of service change.