Ambulatory Hip and Knee Replacement Outcomes During COVID-19 Outbreak in Washington State

# Introduction The first case of COVID-19 in the U.S. was diagnosed on January 19th, 2020 in Washington State and evidence suggested that the virus was circulating in Washington prior to this. Elective joint replacements were suspended on March 19th, 2020 with the goal of preserving resources and protecting patients and workers. This pilot study evaluates a group of patients who underwent elective joint replacement during the initial surge of COVID-19 and before the shutdown of elective surgeries to examine the patient experience of elective joint arthroplasty during a COVID-19 surge. All patients participated in an outpatient joint replacement program utilizing a dedicated patient engagement platform which enabled the investigation of Patient Reported Outcome Measures (PROMs), COVID-19 surveys, as well as patient satisfaction outcomes. # Methods This observational study reviewed 282 patients who underwent hip and knee arthroplasty in Washington State during the COVID-19 surge between January and March 2020. Surgeries were done by surgeons experienced in outpatient techniques using a standardized protocol. Patients registered on a dedicated cloud platform (The SwiftPath Program, LLC). Patient education emphasized the benefits of early discharge and recovery at home. The patient experience included shared-decision-making and a vetted risk stratification algorithm. Homecare monitoring allowed for notifications to the care team as well as opiate tracking, recovery milestones, and PROs. Patients responded to postoperative homecare queries, satisfaction surveys, and standardized PROs surveys (HOOS JR., KOOS JR., PROMIS) at baseline and routine post-op intervals out to 6 weeks. A follow-up “COVID-19 survey” was also used to specifically evaluate exposure to and complications from potential COVID-19 infection. # Results There were 254 patients out of 282 (90.0%) who registered and had partially completed the data collection. The average age of patients was 67.7 years old (range 30 – 91). Fifty-nine patients (23.2%) completed HOOS JR. and KOOS JR. data, and of these patients, 46 were knee replacements, and 13 were hip replacements. Every patient who responded both to the preoperative and postoperative HOOS JR. and KOOS JR. questionnaires had improved scores by six weeks postoperatively. Of the 180 patients who responded to the COVID-19 survey, none reported viral symptoms or developed COVID-19. Patients indicated limited physical therapy access, but recovery was not impacted. The average surgery satisfaction during the pandemic was 9.3/10.0. # Conclusion An online patient engagement platform can help monitor the clinical course, PROs as well as any virus-related illnesses in patients undergoing TJA. Information from PROs can be used to evaluate outcomes during a pandemic. Additional studies should focus on larger numbers of patients and compare PROs with clinical outcomes to help document the safety of performing elective surgeries during pandemics.