Clinical outcome before and after COVID-19 quarantine in patients affect of knee and hip osteoarthritis Experience of orthopedic department in one of the first European country involved in COVID-19 pandemic.

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Marco Mattia Larghi
Miriam Grassi
Faugno Luca
Emanuele Placenza
Corrado Rampulla
Alfonso Manzotti


Hip arthroplasty; clinical outcome; COVID-19; Quarantine; hip replacement; pre-operative planning.



The emergency caused by COVID-19 Pandemia has resulted in a complete suspension and consequent delay of common planned surgery such total hip replacement in patients affect by osteoarthritis. At the same time, the issue of the quarantine imposed changes to the normal lifestyle of these patients. The purpose of our study is to evaluate how the presence of these two factors affect the quality of live of patients living in the Italian red zone.


From outpatient pre-operative assessment we collect data about: demographic data, WOMAC score, NRS (Numeric rating scale 0-10), PCS SF12 and MCS SF12 score. Selected patients were therefore contacted by telephone call and re-assess using the same score. In addition, patients were asked if they intended to undergo the planned surgery again despite the current emergency


14 patient have been recruited for the study. Male/female ration was 10/4, mean age was 70 years. Pre operative outpatient assessment mean WOMAC score was 44,86 (SD ± 8,52) , mean NRS was 8,07 (SD ± 1,33), PCS SF12 was  30,33 (SD ± 5,0) and MCS SF12 was 40,95 (SD ± 3,51).  At re-evalutation the mean WOMAC score was 32,86 (SD ± 17,88) , mean NRS was 5,79 (SD ± 3,66), PCS SF12 was  39,9 (SD ± 3,70) and MCS SF12 was 50,14 (SD ± 6,86)


The exceptionale pandemic from Covid-19 has profoundly changed our lifestyle, impacting normal daily activities but also on regular surgical activity in patients affected by osteoarthritis. Our study suggested that the lifestyle changes imposed by the situation led to an improvement of clinical score. This shows how an exceptional event can affect many aspects of daily life.


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Armocida B, Formenti B, Ussai S, Palestra F, Missoni E. The Italian health system and the COVID-19 challenge. Lancet Public Health. 2020 May;5(5):e253. doi: 10.1016/S2468-2667(20)30074-8. Epub 2020 Mar 25. PubMed PMID: 32220653; PubMed Central PMCID: PMC7104094.
Ministry of Health of Italy. COVID-19 situazione in Italia. March 19, 2020. http://www.salute. dettaglioContenutiNuovoCoronavirus.jsp?lingu a=italiano&id=5351&area=nuovoCoronavirus& menu=vuoto (accessed March 20, 2020).
Giunta Regione Lombardia Deliberazione N° XI/2906 seduta del 08/03/2020.
Italian National Ministry of Health
De Giorgio A. COVID-19 is not just a flu. Learn from Italy and act now [published online ahead of print, 2020 Apr 6]. Travel Med Infect Dis. 2020;101655. doi:10.1016/j.tmaid.2020.101655
Nussbaumer-Streit B, Mayr V, Dobrescu AI, Chapman A, Persad E, Klerings I, Wagner G, Siebert U, Christof C, Zachariah C, Gartlehner G. Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review. Cochrane Database Syst Rev. 2020 Apr 8;4:CD013574. doi: 10.1002/14651858.CD013574. PubMed PMID: 32267544; PubMed Central PMCID: PMC7141753.
Covid-19: D.P.C.M. 11 marzo 2020 pubblicato nella Gazzetta Ufficiale n. 64 dell'11 marzo 2020
Ferguson RJ, Palmer AJ, Taylor A, Porter ML, Malchau H, Glyn-Jones S. Hip replacement. Lancet. 2018 Nov 3;392(10158):1662-1671. doi: 10.1016/S0140-6736(18)31777-X. Review. PubMed PMID: 30496081.
Torre M, Romanini E, Zanoli G, et al. Monitoring Outcome of Joint Arthroplasty in Italy: Implementation of the National Registry. Joints. 2017;5(2):70‐78. Published 2017 Jul 28. doi:10.1055/s-0037-1603899
Hughes RE, Batra A, Hallstrom BR. Arthroplasty registries around the world: valuable sources of hip implant revision risk data. Curr Rev Musculoskelet Med. 2017;10(2):240‐252. doi:10.1007/s12178-017-9408-5
Gademan MG, Hofstede SN, Vliet Vlieland TP, Nelissen RG, Marang-van de Mheen PJ. Indication criteria for total hip or knee arthroplasty in osteoarthritis: a state-of-the-science overview. BMC Musculoskelet Disord. 2016;17(1):463. Published 2016 Nov 9. doi:10.1186/s12891-016-1325-z
Specht K, Kjaersgaard-Andersen P, Kehlet H, Wedderkopp N, Pedersen BD. High patient satisfaction in 445 patients who underwent fast-track hip or knee replacement. Acta Orthop. 2015;86(6):702‐707. doi:10.3109/17453674.2015.1063910
Kamal T, Conway RM, Littlejohn I, Ricketts D. The role of a multidisciplinary pre-assessment clinic in reducing mortality after complex orthopaedic surgery. Ann R Coll Surg Engl. 2011 Mar;93(2):149-51. doi: 10.1308/003588411X561026. PubMed PMID: 22041145; PubMed Central PMCID: PMC3293311.
Bernstein DN, Liu TC, Winegar AL, Jackson LW, Darnutzer JL, Wulf KM, Schlitt JT, Sardan MA, Bozic KJ. Evaluation of a Preoperative Optimization Protocol for Primary Hip and Knee Arthroplasty Patients. J Arthroplasty. 2018 Dec;33(12):3642-3648. doi: 10.1016/j.arth.2018.08.018. Epub 2018 Aug 22. PubMed PMID: 30201213.
Kodraliu G, Mosconi P, Groth N, Carmosino G, Perilli A, Gianicolo EA, Rossi C, Apolone G. Subjective health status assessment: evaluation of the Italian version of the SF-12 Health Survey. Results from the MiOS Project. J Epidemiol Biostat. 2001;6(3):305-16. PubMed PMID: 11437095.
Salaffi F, Leardini G, Canesi B, Mannoni A, Fioravanti A, Caporali R, Lapadula G, Punzi L; GOnorthrosis and Quality Of Life Assessment (GOQOLA). Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee. Osteoarthritis Cartilage. 2003 Aug;11(8):551-60. PubMed PMID: 12880577.
Ornetti P, Dougados M, Paternotte S, Logeart I, Gossec L. Validation of a numerical rating scale to assess functional impairment in hip and knee osteoarthritis: comparison with the WOMAC function scale. Ann Rheum Dis. 2011 May;70(5):740-6. doi: 10.1136/ard.2010.135483. Epub 2010 Dec 13. PubMed PMID: 21149497.
Cibulka MT, White DM, Woehrle J, et al. Hip pain and mobility deficits--hip osteoarthritis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2009;39(4):A1‐A25. doi:10.2519/jospt.2009.0301
Kapstad H, Rustøen T, Hanestad BR, Moum T, Langeland N, Stavem K. Changes in pain, stiffness and physical function in patients with osteoarthritis waiting for hip or knee joint replacement surgery. Osteoarthritis Cartilage. 2007 Jul;15(7):837-43. Epub 2007 Mar 6. PubMed PMID: 17344069.
Nguyen UDT, Perneger T, Franklin PD, Barea C, Hoffmeyer P, Lübbeke A. Improvement in mental health following total hip arthroplasty: the role of pain and function. BMC Musculoskelet Disord. 2019;20(1):307. Published 2019 Jun 29. doi:10.1186/s12891-019-2669-y
Gerbershagen HJ, Rothaug J, Kalkman CJ, Meissner W. Determination of moderate-to-severe postoperative pain on the numeric rating scale: a cut-off point analysis applying four different methods. Br J Anaesth. 2011 Oct;107(4):619-26. doi: 10.1093/bja/aer195. Epub 2011 Jun 30. PubMed PMID: 21724620.
Koutras C, Antoniou SA, Talias MA, Heep H. Impact of Total Hip Resurfacing Arthroplasty on Health-Related Quality of Life Measures: A Systematic Review and Meta-Analysis. J Arthroplasty. 2015 Nov;30(11):1938-52. doi: 10.1016/j.arth.2015.05.014. Epub 2015 May 19. Review. PubMed PMID: 26067708.
Krauß I, Steinhilber B, Haupt G, Miller R, Martus P, Janßen P. Exercise therapy in hip osteoarthritis--a randomized controlled trial. Dtsch Arztebl Int. 2014 Sep 1;111(35-36):592-9. doi: 10.3238/arztebl.2014.0592. PubMed PMID: 25249361; PubMed Central PMCID: PMC4174683.
Fernandopulle S, Perry M, Manlapaz D, Jayakaran P. Effect of Land-Based Generic Physical Activity Interventions on Pain, Physical Function, and Physical Performance in Hip and Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil. 2017 Nov;96(11):773-792. doi: 10.1097/PHM.0000000000000736. Review. PubMed PMID: 28323761.
Rahman WA, Greidanus NV, Siegmeth A, Masri BA, Duncan CP, Garbuz DS. Patients report improvement in quality of life and satisfaction after hip resurfacing arthroplasty. Clin Orthop Relat Res. 2013;471(2):444‐453. doi:10.1007/s11999-012-2645-4
Bartley EJ, Palit S, Staud R. Predictors of Osteoarthritis Pain: the Importance of Resilience. Curr Rheumatol Rep. 2017;19(9):57. doi:10.1007/s11926-017-0683-3
Sofat N, Ejindu V, Kiely P. What makes osteoarthritis painful? The evidence for local and central pain processing. Rheumatology (Oxford). 2011 Dec;50(12):2157-65. doi: 10.1093/rheumatology/ker283. Epub 2011 Sep 27. Review. PubMed PMID: 21954151.
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int J Environ Res Public Health. 2020 Mar 6;17(5). pii: E1729. doi: 10.3390/ijerph17051729. PubMed PMID: 32155789; PubMed Central PMCID: PMC7084952.
van Baar ME, Dekker J, Lemmens JA, Oostendorp RA, Bijlsma JW. Pain and disability in patients with osteoarthritis of hip or knee: the relationship with articular, kinesiological, and psychological characteristics. J Rheumatol. 1998 Jan;25(1):125-33. PubMed PMID: 9458215.
Xiao C. A novel approach of consultation on 2019 novel coronavirus (COVID-19) related psychological and mental problems: structured letter therapy. Psychiatry Investig. 2020. 17 (2), 175–176.
Xiao, H.,Zhang,Y., Kong, D., Li, S.,Yang,N., 2020a.The effects of social support on sleep quality of medical staff treating patients with coronavirus disease 2019 (COVID-19) in January and February 2020 in China. Med. Sci. Monit. 26, e923549.
Liu, S., Yang, L., Zhang, C., Xiang, Y.T., Liu, Z., Hu, S., Zhang, B., 2020a. Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry 7 (4), e17–e18.
Ravi PR. COVID-19 and mental health: A review of the existing literature. Asian Journal of Psychiatry 2020 Aug; 52: 1-5.