In mid-March, all non-urgent elective surgery was cancelled in both the NHS and private sector in response to the COVID-19 pandemic. With numbers of infections and related deaths falling daily, Health Secretary Matt Hancock recently announced that some healthcare services would resume over the next few weeks.
Certain areas were to be prioritised, including cancer care, acute cardiac surgery, cardiology services and the management of patients with severe heart failure and stroke services. In a letter to NHS trusts from NHS England’s chief executive, a further directive was that hospitals should also restart routine elective procedures where additional capacity was available, prioritising those with long waits.
So, what does this mean for planned hip and knee replacement surgery? As London hip & knee replacement surgeon Mr Simon Bridle explains, performing major surgery during a pandemic is potentially high risk, with one small scale study from Wuhan, China, that found 20% mortality rates in patients that underwent major surgery during the height of the pandemic there.
Both private and NHS hospitals will need to adopt brand new infection control processes to minimise these risks. These clean hospitals will be called green centres, with hospitals that treat COVID-19 patients deemed blue and the principle is try and keep green and blue apart. Patients admitted to a green hospital will need to isolate prior to their admission and have a negative COVID-19 swab prior to admission. Green hospitals will have very stringent infection control policies and pathways in place.
The exact role of the private sector is unknown at this moment. The NHS’s contract with the private sector that is currently in place will end in June. It may well be that in some areas, the NHS will choose to use private hospital as green centres for elective surgery.
Although we hope to resume joint replacement in some patients in the next few weeks, it may be some months before joint replacement surgery is carried out as a matter of course. Patients’ individual risk will be analysed and this will inform decision making between the surgeon and patient about proceeding to surgery, bearing in mind that many patients are in pain and losing their mobility and independence as a result of joint deterioration. Patients will have to accept a small increased risk, which will be weighed against those of not going ahead with surgery at this stage.
To discuss how we are planning to deal with the COVID-19 pandemic and the implications of delaying joint replacement surgery in more depth with Mr Simon Bridle, he is currently offering remote consultations, either by telephone or video link, and face-to-face consultations when necessary. Consultations can be arranged by contacting his PA Adriana by calling 020 8947 9524 or emailing email@example.com.