Consequences for preoperative pain and function when postponing elective knee and hip arthroplasty.

INTRODUCTION: The coronavirus outbreak causes postponement of elective surgery. We evaluated how pain, function and general health were impacted by postponing elective knee and hip arthroplasty in patients with knee and hip osteoarthritis with no known surgery rescheduling date due to the coronavirus outbreak. METHODS: This study included 194 patients from a Danish public hospital with postponed elective primary knee or hip arthroplasty due to the lockdown. Patients responded to questionnaires when their surgery was cancelled and before surgery. Changes in pain and function were evaluated with the Oxford Knee and Hip Scores (OKS, OHS) and their general health with the EuroQol 5-dimension scale (EQ5D). Additionally, we asked about the patients' concerns and whether they felt improved, unchanged or deteriorated during the waiting period. RESULTS: Complete data were obtained for 110 (57%) patients, 59 and 51 awaiting knee or hip arthroplasty (median age 71 years, 62% were female), respectively. Arthroplasty was postponed for a median (range) 98 (63-161) days. A total of 34% were concerned that the postponement would lead to a poorer outcome. Mean OKS and OHS differences were 0 (95% confidence interval (CI): -1-1) and -1 (95% CI: -2-0) from surgery cancellation to re-scheduled surgery. The mean EQ5D index difference was 0.0 (95% CI: 0.0-0.1) for both groups. A total of 75 (68%) patients felt an important deterioration of their condition. CONCLUSIONS: Pre-operatively, patients worried about experiencing an altered treatment outcome due to postponed surgery and felt that their condition had deteriorated during the waiting period although this was not reflected in patient-reported outcome measures. FUNDING: Department of Orthopaedic Surgery. TRIAL REGISTRATION: not relevant.

White blood cell scintigraphy for differentiation of infection and aseptic loosening: a retrospective study of 76 painful hip prostheses.

BACKGROUND: Diagnosis of an infected arthroplasty is often difficult. Fever, abnormal physical findings, radiographic changes, findings at bone scintigraphy, an elevated erythrocyte sedimentation rate, CRP, and leucocytosis are not specific enough. We evaluated the diagnostic value of white blood cell scintigraphy. METHODS: We retrospectively reviewed 76 cases (66 patients) admitted for white blood cell scintigraphy with a clinical suspicion of infection in a hip prosthesis during the period 1995-2003. The leukocytes were labeled with (99m)Tc-HMPAO or with (111)In-oxin. Anterior and posterior views were taken of both hip joints at 3 different time points after injection: 1 h, 3 h, and 22 h. Infection was verified by means of bacteriological cultures, histopathological findings, intraoperative frozen sections, and follow-up (up to 3.5 years). RESULTS: Of 76 scintigraphies, 51 were negative and 25 were positive. There were 81% true positive, 94% true negative, 6% false positive, and 19% false negative outcomes. INTERPRETATION: White blood cell scintigraphy with additional late imaging is an effective tool for differentiation between loosening and infection in painful hip arthroplasty.