Total Knee Arthroplasty During the COVID-19 Pandemic: Rapid Return to Baseline Volume and Continuation of Trend Toward Outpatient Surgery

Abstract

Background: COVID-19 was a major disruptor in the United States throughput of total knee arthroplasty (TKA). After elective surgery resumed following initial suspensions, restrictions waxed and waned as COVID-19 waves peaked and ebbed. The specific impact of the pandemic on overall and outpatient TKA volume has not been fully studied. Purpose: Thus, this study aimed to observe how TKA volume and that proportion performed on an outpatient basis evolved through the pandemic. Methods: The PearlDiver database was utilized to identify patients undergoing elective TKA, from January 2018 to April 2021. Descriptive analysis was utilized to report the monthly changes in elective TKA volume and the proportion performed in the outpatient setting. A linear forecast analysis using historical data was utilized to determine the expected volume and proportion performed outpatient during the pandemic. This was compared to the observed case volume and setting. Results: Within 3 months following suspension of elective TKA, the total volume had returned to what was expected (Actual: 15,692; Expected: 15,586 (95% CI: 13,345-17,738). During the third peak of the pandemic, volume decreased but returned to projections within 2 months (Actual: 16,227; Expected: 17,181 (95% CI: 14,540-19,823). The pandemic did not cause the proportion of outpatient cases to differ from pre-pandemic predictions. Conclusion: In this nationwide analysis, the pandemic was not shown to have a lasting effect on TKA volume. The shift toward outpatient TKA during the pandemic seems likely to have represented a transition which had already begun prior to March 2020.