COVID-19 Has Delayed My Joint Surgery, but I Still Hurt…

As the COVID-19 virus has brought the world to a halt, some 'elective' surgeries such as joint replacements have been postponed. Dr. Dumont shares why this has happened and some things you can do in the meantime.

The COVID-19 pandemic has reshaped the way our world functions in a relatively short time frame. Many of us are anxious about doing simple things like going to the grocery store. We can’t be with many of our friends and family during this period of social distancing, quarantines, and isolation. If you have joint pain from arthritis or an injury and have been waiting for surgery, it’s very likely that this surgery has been postponed. Certainly, this can be frustrating. After all, your pain is real and the surgical solution you thought was within reach now is indefinitely delayed.

First, it’s important to discuss what the term ‘elective’ surgery means. The term can make some patients upset, because it implies that you chose to be hurt or impaired. On the contrary, nobody ‘elects’ to have hip or knee arthritis, to tear their rotator cuff, or have hand numbness from carpal tunnel syndrome.

In March, the Surgeon General and the Centers for Disease Control recommended the cancellation of elective procedures.1 States, hospital systems, and individual surgeons made decisions on whether or not to proceed with various surgeries. Most surgeons would agree that there are certain time sensitive procedures that should still be performed. Though the definitions and algorithms vary to determine which surgeries are okay to perform, in general, conditions like fractures that require surgical repair, infections, certain tumors, and injuries risking progressive nerve or spine damage often fall in this category. The American Academy of Orthopedic Surgeons has also published the “AAOS Guidelines on Elective Surgery During the COVID-19 Pandemic” to help guide your surgeon in making these very difficult decisions.

So what’s the harm in doing orthopedic surgeries?

Although it may seem that in your particular location, hospitals are doing okay and continue to have available beds for patients, the COVID-19 pandemic is placing enormous stress on healthcare systems.  There are a lot of challenges. There’s a very real concern for how much personal protective equipment (PPE) is, and will be, available for healthcare workers treating patients on the front lines of the infection. If these people do not have the appropriate PPE, they have a very high risk of contracting the virus, which either means they can transmit it to others, become seriously sick themselves, or both. 

Any surgical procedure is a team sport. Several individuals in the operating room require gowns and masks, often including the surgeon, nurses, surgical technicians and assistants, anesthesiologists, and nurse anesthetists. Even if a relatively small day of surgery is performed, a lot of PPE is utilized.  Although industries will eventually catch up in making more masks and gowns, we cannot replace the people that are risking their own health. Some cities are facing the challenging task of re-assigning their doctors, nurses, and other staff to different roles just to be able to keep up with coronavirus patient volumes. 

Ventilators are also a topic of discussion. On a normal day when a viral pandemic is not occurring, ventilators in the intensive care unit aren’t something we, as a society, give much thought to. For patients that develop Severe Acute Respiratory Syndrome (SARS) from the COVID-19 virus, a ventilator may be their only hope of living. With the surge in number of patients needing ventilators, machines used to support breathing during surgical anesthesia can be repurposed to service as ventilators. This means we need to be very conscious of when we choose to use these machines for non-urgent procedures. 

All of this doesn’t take away the fact that your knee, hip, shoulder, or toe is hurting. As an orthopedic surgeon, it’s tough to sit on the sidelines and watch our patients hurt. Our entire careers are built around doing everything we can to heal our patient’s ailments and return them to better function. 

So, what can you do in the meantime?

  • Simple measures like ice, heat, over the counter pain relievers like acetaminophen, gentle stretching, and massage can all be helpful. They aren’t perfect - but for now they’re what we have to work with.
  • Maintaining a routine that includes a healthy, balanced diet and even some light exercises can help you stay physically conditioned and also reduce stress and anxiety. Though your injury or condition may limit your activity and ability to exercise - any little bit can help. Something as simple as a floor peddler to keep your leg muscles moving, or a modest walk (while maintaining social distancing measures) can add structure to your day and help build a sense of accomplishment that’s important during this odd time. 
  • Creating a task list on the evening before each day can take just a few minutes but prove helpful to create structure.
  • Finish small projects around the house that you typically can’t find time for. 

If your pain isn’t manageable with home measures, call your doctor. Many orthopedic offices are offering telemedicine options in order to assess your concerns without bringing you in for a physical visit. Many physical therapy offices have also begun doing the same. In short, your musculoskeletal health team is still there for you.  

We all have a role to play in how this pandemic progresses. For some, that means 12-hour shifts intubating patients that are having trouble breathing. For others, it means helping society continue to function by staffing a grocery store checkout line, restocking empty shelves, or collecting trash to keep our neighborhoods sanitary. For an overwhelming majority of people, our contribution is to simply stay home, wash our hands often, and stay 6 feet away from people if we absolutely need to be out. We cannot understate the importance of each of these categories. They all matter so much.

The world will normalize over time and this too shall pass. The passage though will not likely be easy. It will have taken its toll on the global economy, our societal and community cultures, and most of all it will have taken many lives. Know that, as your doctors and healthcare workers, we care for you tremendously and appreciate your patience while you wait for surgery.

References
  1. Sealander, K., et al. (2020, Mar 22). How to Handle Elective Surgeries and Procedures During the Covid-19 Pandemic. McDermott, Will & Emery. www.mwe.com/insights/how-to-handle-elective-surgeries-and-procedures-during-the-covid-19-pandemic/
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