Published online Oct 16, 2023. doi: 10.12998/wjcc.v11.i29.7043
Peer-review started: June 27, 2023
First decision: August 4, 2023
Revised: September 11, 2023
Accepted: September 22, 2023
Article in press: September 22, 2023
Published online: October 16, 2023
Total knee arthroplasty (TKA) served as the last resort for individuals with severe knee osteoarthritis (OA), reducing burdens from pain and symptoms which interfere with activities of daily living. Upon happening of coronavirus disease 2019 (COVID-19), health care setting was overloaded with critical medical condition patients, rendering scheduled surgeries postponed. The consequences of delayed TKA remain unknown. As the capital of Malaysia, Kuala Lumpur has hospitals that served during COVID-19, hence is suitable to be appointed as the location for sample recruitment.
OA is a high prevalence degenerative joint disease, in Malaysia, patients with late-stage OA are usually appointed for TKA as last resort of treatment. Due to COVID-19, their TKA had to be rescheduled, the impact this adjustment should be aware as movement restriction during the pandemic left the patients with self-management to deal with knee pain and symptoms, their physical function and quality of life may worsen if misguided practice was done. The significance of understanding how length of TKR waiting time affects pain, physical frailty and overall health may provide input for physician to plan future guidelines in TKR.
The research objective of this study is to investigate the effects of COVID-19 pandemic on self-management, pain, and physical function in older adults awaiting TKA in Malaysia. By examining the length of TKR waiting time and the self-management, pain, and physical function of older adults with knee OA, we may provide input for healthcare providers in creating emergency protocols for future pandemics that may cause further postponements of elective surgeries.
Using information from a TKA registry, this study employed a cross-sectional survey approach to assess the impact of surgical postponement on patient health status and self-management during the COVID-19 pandemic. Data were anonymously gathered from the Department of Orthopaedic at the Hospital Canselor Tuanku Mukhriz (HCTM) in Malaysia on patients who were in the waiting period for elective TKA between January 2021 and May 2022. The HCTM caters approximately 500000 Malaysian citizens who lived in the areas of Cheras, Ampang, Hulu Langat, Semenyih and Bangi. Patients who had undergone TKR surgery or had an appointment for a revision were not included. Data for this study was gathered on-site. The study was divided into two stages: The first stage included data extraction from the TKA registry, and the second stage comprised performing a survey on patients’ health state and self-management. The survey questionnaires were disseminated after contacting them and obtaining their agreement.
Based on sample size of 50 older adults, the study found a significant association between pain intensity and physical frailty even after adjustment for age and self-management practices, however, not between length of TKR waiting time and poor physical function or frailty. The chronic comorbidities may be one of the factors. Over half of the participants exercise on daily basis, and yet 72% of the participants were found to have physical frailty. This suggests exercise alone is not enough, psychological intervention, patient education, and monitoring, for example, remote telecommunication consultation may aid in the management.
This study did not find significant association between waiting time for TKA surgery and poor physical function or frailty, suggesting the postponement was not the main factor that bore negative effect on self-management, pain, and physical function in emphasized that older patients aged 50 and above were disproportionately impacted by the postponement of TKA procedures due to the COVID-19 pandemic. Nevertheless, the significant association between pain and physical frailty. It highlights the importance of closely monitoring these patients for OA pain management treatment during the waiting period to prevent declines in physical function and frailty, and to maintain their independence.
Future research may focus on creating emergency protocols for future pandemics that may cause further postponements of elective surgeries. The management should include and investigate the synergy effect of psychological intervention, patient education and monitoring with exercise.