Pain and function deteriorate in patients awaiting total joint arthroplasty that has been postponed due to the COVID-19 pandemic

Table 1 Coronavirus disease 2019 arthroplasty waiting list questionnaire response results

Section I: Demographic data
Age in yr, mean ± SD	50.28 ± 8.9
Gender, n (%)
Male	63 (34.05)
Female	122 (65.95)
TJA, n (%)
TKA	106 (57.3)
THA	79 (42.7)
Awaiting TJA in mo, mean ± SD	26.42 ± 30.1
Number of comorbidities, n (%)
0	59 (31.89)
1	95 (51.35)
2	29 (15.68)
3	2 (1.08)
Comorbidities, n (%)
DM	27 (14.59)
HPT	89 (48.11)
TB	5 (2.70)
Cardiac disease	9 (4.86)
Asthma	12 (6.49)
Lung disease	5 (2.70)
HIV	18 (9.73)
Demand for TJA despite COVID-19 pandemic, n (%)
Yes	163 (88.11)
No	22 (11.89)
Section II: Pain and function
Joint pain since postponement of TJA, n (%)
Decreased	23 (12.64)
Same	58 (31.87)
Increased	101 (55.49)
Access to pain medication, n (%)
Yes	90 (72)
No	35 (28)
NRS pain score, mean ± SD	7.37 ± 2.24
Current state in comparison to before TJA postponement	n (%)
Functionality due to joint pain
Much less	24 (13.11)
Less	99 (54.1)
Same	50 (27.32)
More	5 (2.73)
Much more	5 (2.73)
Walking distance
Much less	30 (16.3)
Less	59 (32.07)
Same	88 (47.83)
More	6 (3.26)
Much more	1 (0.54)
Sitting
Much less	18 (9.89)
Less	57 (31.32)
Same	101 (55.49)
More	6 (3.3)
Much more	0 (0)
Sleep
Much less	25 (13.59)
Less	25 (13.59)
Same	104 (56.52)
More	20 (10.87)
Much more	10 (5.43)
Need for pain medication
Much less	8 (4.57)
Less	12 (6.86)
Same	74 (42.29)
More	47 (26.86)
Much more	34 (19.43)
Section III: Mental health	n (%)
Weight change since TJA postponement
Lost	33 (25.98)
Same	56 (44.09)
Gained	38 (29.92)
Feelings of isolation or loneliness
Yes	59 (32.78)
No	121 (67.22)
Anxiety to get infected with COVID-19
No	28 (15.3)
Minimal	20 (10.93)
Neutral	22 (12.02)
Moderate	47 (25.68)
Severe	66 (36.07)
Anxiety to spread COVID-19 to relatives
No	28 (15.64)
Minimal	17 (9.5)
Neutral	14 (7.82)
Moderate	39 (21.79)
Severe	81 (45.25)
Anxiety about Finances due to COVID-19
No	18 (10)
Minimal	20 (11.11)
Neutral	82 (45.56)
Moderate	40 (22.22)
Severe	20 (11.11)
Section IV: Insight
Understanding of healthcare system response to COVID-19	n (%)
Aware no elective surgery
Yes	137 (74.05)
No	48 (25.95)
Fair no elective surgery
Yes	157 (84.86)
No	28 (15.14)
Important to delay elective surgery
Yes	162 (87.57)
No	23 (12.43)
Knowledge of preventative measures	n (%)
Hand washing
Yes	124 (67.03)
No	62 (32.97)
Social distancing
Yes	124 (67.03)
No	62 (32.97)
Wearing mask in public
Yes	123 (66.49)
No	63 (33.51)
Peri-operative patient considerations for COVID-19	n (%)
Routine pre-operative screening
Yes	122 (89.1)
No	15 (10.9)
Increased morbidity if COVID-19 positive
Yes	120 (88.9)
No	15 (11.1)
No visitors allowed
Yes	114 (87)
No	17 (13)
Increased mortality if COVID-19 positive
Yes	92 (67.2)
No	45 (32.8)
Patient education and counselling
Still demand TJA despite COVID-19 pandemic	n (%)
Yes	100 (54.05)
No	85 (45.95)

COVID-19: Coronavirus disease 2019; DM: Diabetes mellitus; HIV: Human immunodeficiency virus; HPT: Hypertension; NRS: Numerical rating scale; SD: Standard deviation; TB: Tuberculosis; THA: Total hip arthroplasty; TJA: Total joint arthroplasty; TKA: Total knee arthroplasty.

Table 2 Pain and function responses compared between patients that wanted total joint arthroplasty despite the coronavirus disease 2019 pandemic (Yes) to patients that did not want elective surgery as soon as possible (No)¹

Current state in comparison to before TJA postponement	Want TJA despite COVID-19 pandemic		P value
Function	Yes, n (%)	No, n (%)
Functionality due to joint pain			0.002
Much less	26 (16.05)	0 (0)
Less	89 (54.94)	8 (38.1)
Same	42 (25.93)	8 (38.1)
More	2 (1.23)	4 (19.05)
Much more	3 (1.85)	1 (4.76)
Walking distance			0.034
Much less	27 (16.56)	3 (14.29)
Less	55 (33.74)	3 (14.29)
Same	77 (47.24)	11 (52.38)
More	3 (1.84)	4 (19.05)
Much more	1 (0.61)	0 (0)
Sitting			0.63
Much less	15 (9.2)	3 (15.97)
Less	53 (32.52)	4 (21.05)
Same	90 (55.21)	11 (57.89)
More	5 (3.07)	1 (5.26)
Sleep			0.572
Much less	21 (12.88)	4 (19.05)
Less	21 (12.88)	4 (19.05)
Same	94 (57.67)	10 (47.62)
More	19 (11.66)	1 (4.76)
Much more	8 (4.91)	2 (9.52)
Pain	Yes, n (%)	No, n (%)
Joint pain			0.037
Decreased	20 (12.27)	3 (15.79)
Same	48 (29.45)	10 (52.63)
Increased	95 (58.28)	6 (31.58)
Access to pain medication			0.714
No	30 (27.03)	5 (35.71)
Yes	81 (72.97)	9 (64.29)
Need for pain medication			0.05
Much less	6 (3.87)	2 (10)
Less	8 (5.16)	4 (20)
Same	65 (41.94)	9 (45)
More	44 (28.39)	3 (15)
Much more	32 (20.65)	2 (10)
	Yes, mean (± SD)	No, mean (± SD)	P value
NRS pain score	7.54 ± 2.02	3.09 ± 3.27	< 0.000

¹Yes (n = 164); No (n = 21). COVID-19: Coronavirus disease 2019; NRS: Numerical rating scale; SD: Standard deviation; TJA: Total joint arthroplasty.

Table 3 Mental health responses compared between patients that wanted total joint arthroplasty despite the coronavirus disease 2019 pandemic (Yes) to patients that did not want elective surgery as soon as possible (No)¹

Mental health responses	Want TJA despite COVID-19 Pandemic, n (%)		P value
	Yes	No
Weight change since TJA postponement			0.423
Lost	30 (27.03)	3 (18.75)
Same	50 (45.05)	6 (37.50)
Gained	31 (27.93)	7 (43.75)
Feelings of isolation or loneliness			0.89
Yes	51 (32.48)	8 (34.78)
No	106 (67.52)	15 (65.22)
Anxiety to get infected with COVID-19			0.133
No	15.43	14.29
Minimal	10.49	14.29
Neutral	9.88	28.57
Moderate	26.54	19.05
Severe	37.65	23.81
Anxiety to spread COVID-19 to relatives			0.016
No	26 (16.46)	2 (9.52)
Minimal	13 (8.23)	4 (19.05)
Neutral	9 (5.7)	5 (23.81)
Moderate	35 (22.15)	4 (19.05)
Severe	75 (47.47)	6 (28.57)
Anxiety about finances due to COVID-19			0.785
No	16 (10.06)	2 (9.52)
Minimal	36 (22.64)	4 (19.05)
Neutral	70 (44.03)	12 (57.14)
Moderate	19 (11.95)	1 (4.76)
Severe	18 (11.23)	2 (9.52)

¹Yes (n = 164); No (n = 21). COVID-19: Coronavirus disease 2019; TJA: Total joint arthroplasty.

Table 4 Pain and function responses compared between the continued demand group, defer group and receptive group¹

Current function in comparison to before TJA postponement	Continued demand group, n (%)	Defer group, n (%)	Receptive group, n (%)	P value
Functionality due to joint pain				0.043
Much less	15 (15.31)	0 (0)	9 (14.06)
Less	59 (60.20)	10 (50)	30 (46.88)
Same	19 (19.39)	6 (30)	24 (37.5)
More	2 (2.04)	3 (15)	0 (0)
Much more	3 (3.06)	1 (5)	1 (1.56)
Walking distance				0.118
Much less	21 (21.21)	2 (10)	7 (10.94)
Less	29 (29.29)	4 (20)	25 (39.06)
Same	46 (46.46)	11 (55)	31 (48.44)
More	2 (2.02)	3 (15)	1 (1.56)
Much more	1 (1.01)	0 (0)	0 (0)
Sitting				0.518
Much less	12 (12.12)	2 (11.11)	4 (6.25)
Less	29 (29.29)	4 (22.22)	23 (35.94)
Same	53 (53.54)	11 (61.11)	37 (57.81)
More	5 (5.05)	1 (5.56)	0 (0)
Sleep				0.643
Much less	13 (13.13)	3 (15)	9 (14.06)
Less	15 (15.15)	4 (20)	6 (9.38)
Same	50 (50.51)	10 (50)	43 (67.19)
More	14 (14.14)	1 (5)	5 (7.81)
Much more	7 (7.07)	2 (10)	1 (1.56)
Current pain in comparison to before TJA postponement	Continued demand group, n (%)	Defer group, n (%)	Receptive group, n (%)	P value
Joint pain				0.035
Decreased	10 (10.10)	3 (16.67)	10 (15.62)
Same	29 (29.29)	9 (50)	20 (31.25)
Increased	60 (60.61)	6 (33.33)	34 (53.12)
Access to pain medication				0.792
No	19	5	11
Yes	51	9	30
Need for pain medication				0.068
Much less	5 (5.26)	2 (10.53)	1 (1.67)
Less	7 (7.37)	4 (21.05)	1 (1.67)
Same	34 (35.79)	9 (47.37)	31 (51.67)
More	26 (27.37)	3 (15.79)	17 (28.33)
Much more	23 (24.21)	1 (5.26)	10 (16.67)
NRS pain score, mean (± SD)	Continued demand group	Defer group	Receptive group	P value
	7.68 ± 2.14	5.9 ± 3.2	7.24 ± 1.8	< 0.000

¹Continued demand (n = 100); Defer (n = 21); Receptive (n = 64). NRS: Numerical rating scale; SD: Standard deviation; TJA: Total joint arthroplasty.

Table 5 Responses for Insight Perception Regarding coronavirus disease 2019 compared between the continued demand group, defer group and receptive group¹

Insight responses	Continued demand group, n (%)	Defer group, n (%)	Receptive group, n (%)	P value
Healthcare system response to COVID-19
Aware no elective surgery				0.951
Yes	73 (74.49)	15 (75)	48 (75)
No	25 (25.51)	5 (25)	16 (25)
Fair no elective surgery				0.710
Yes	82 (82.83)	17 (85)	57 (89.06)
No	17 (17.17)	3 (15)	7 (10.94)
Important to delay elective surgery				< 0.000
Yes	85 (91.4)	21 (100)	50 (81.97)
No	8 (8.6)	0 (0)	11 (18.03)
Knowledge of preventative measures
Hand washing				0.441
Yes	69 (69.70)	14 (66.67)	41 (64.06)
No	30 (30.30)	7 (33.33)	23 (35.94)
Social distancing				0.441
Yes	69 (69.70)	14 (66.67)	41 (64.06)
No	30 (30.30)	7 (33.33)	23 (35.94)
Wearing mask in publicYes	68 (68.69)	14 (66.67)	41 (64.06)	0.489
No	31 (31.31)	7 (33.33)	23 (35.94)
Peri-operative patient considerations for COVID-19
Routine pre-operative screening				0.016
Yes	94 (94)	18 (85.71)	44 (73.33)
No	6 (6)	3 (14.29)	16 (26.67)
Increased morbidity if COVID-19 positive				0.046
Yes	89 (91.75)	21 (100)	46 (76.67)
No	8 (8.25)	0 (0)	14 (23.33)
No visitors allowed				0.018
Yes	85 (91.4)	18 (85.71)	44 (73.33)
No	8 (8.6)	3 (14.29)	16 (26.67)
Increased mortality if COVID-19 positive				0.001
Yes	77 (77)	18 (85.71)	26 (43.33)
No	23 (23)	2 (14.29)	34 (56.67)

¹Continued demand (n = 100); Defer (n = 21); Receptive (n = 64). COVID-19: Coronavirus disease 2019.