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Covid-19 Backlog and Dealing with Delayed Surgery

5th July 2021

Covid-19 and the strict lockdowns in the UK disrupted the healthcare industry, amongst many other things. Knee osteoarthritis was no exception, and many patients did not get access to therapy or surgery when they needed it. Especially for patients needing immediate care, the indefinite wait can have severe consequences, experts suggest. More specifically, the reduced mobility due to lockdown could cause loss of strength and muscle weight, which will make recovery more challenging. That’s why it is necessary to address these delays and minimize the negative consequences.

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Covid-19 Backlog in The UK

The delays in healthcare solutions for knee OA patients are evident by data.

According to research published in the Lancet Rheumatology Journal, 100,000 patients in the UK were cancelled on getting knee-replacement surgery [1]. The reduced capacity at hospitals has been causing a backlog in the surgery waitlist. Between September 2019 and September 2020, the number of patients in the UK on the NHS waitlist for knee replacement surgery increased by 100-fold and reached 140,000.

Northern Ireland has taken the hardest hit from the Covid-19 backlog. According to a survey of 6000 people, 47% of patients with chronic pain cancelled their appointments during the first lockdown. More than one-third could not get the treatment and medication to manage the pain, while more than half reported that the lack of mobility worsened their symptoms [2].

The delays affected people’s mental health as well. WHO recently reported that 60% of patients waiting for knee surgery developed anxiety disorder or clinical depression [3].

The Current Situation

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The NHS waitlist for treatment continues to rise to record numbers. Currently, 620,003 people with arthritis are on the NHS waitlist, and 92,165 had knee replacements delayed for more than a year [4].

Although clearing the backlog could take a few years, there is some good news as well. For example, the Welsh government has recently announced an investment of £100m into the NHS to increase hospital capacity and equipment. NHS is also constantly working with Versus Arthritis to bring the waiting time to a maximum of 18 weeks.

Solutions for a Delayed Knee Surgery

If you are waiting for your knee replacement surgery, you don’t need to worry because there are still ways to provide relief for your knee OA.

First and foremost, you can practice emotional self-care to deal with the frustration. You might even feel anxious that your knee will become inoperable during the extra waiting, but that is not true. Although delayed surgery means you have to deal with complications for a while, it does not make your knee OA untreatable. Cognitive-behavioral therapy could help you reframe your negative thoughts regarding delayed surgery. Mindfulness practices, breath exercises, and yoga could help you stay mentally strong in times of isolation.

To manage your pain, you should stay as active as possible by continuing daily exercises that will retain your leg muscles and range of motion. Make sure that these activities are low-impact for the knee.If you are able to walk, using a cane or walking pole will reduce the pressure on the knee. If possible, walk in nature to replenish both your body and your mind. Biking, swimming, yoga, elliptical machines, tai chi, and rowing are among recommended activities to manage the pain. If your mobility is restricted due to lockdown or self-isolation, try stretching and strengthening exercises you can do from home.

For unicompartmental knee osteoarthritis, that is valgus or varus knee conditions, it may be beneficial to wear an unloading brace. An unloading knee brace works by taking the pressure off of the areas worst affected by the osteoarthritis and the braces are able to apply corrective forces to the area to improve stability. A knee brace could help get you exercising if you struggle with pain.

When doing physical activities, make sure not to cross your appropriate edge and remember to take breaks as needed.

Conclusion

As the world still fights COVID-19, disturbances in healthcare for knee OA became inevitable. Despite the unfortunate circumstances, you can still maintain a balance through regular exercise and mindfulness until you eventually receive the much-needed and long-awaited treatment.

[1] The Lancet Rheumatology. “Too Long to Wait: the Impact of COVID-19 on Elective Surgery.” The Lancet Rheumatology, vol. 3, no. 2, 2021, doi:10.1016/s2665-9913(21)00001-1.

[2] McKee, P., et al. "OP0265-HPR IMPACT OF COVID-19 PANDEMIC ON RHEUMATOLOGY PATIENTS IN NORTHERN IRELAND–A WEB BASED CROSS-SECTIONAL SURVEY." (2021): 161-162.

[3] Cisternas, Alvaro F., et al. "Unintended consequences of COVID-19 safety measures on patients with chronic knee pain forced to defer joint replacement surgery." Pain Reports 5.6 (2020).

[4] “Almost 5m People Now Waiting for Hospital Treatment in England.” The Guardian, Guardian News and Media, 13 May 2021, www.theguardian.com/society/2021/may/13/hospital-waiting-list-numbers-in-england-hit-record-high.

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