Impact of the COVID-19 Pandemic on Total Knee Arthroplasty Outcomes in US Veterans

Introduction Previous studies demonstrate that retired service members who undergo total joint arthroplasty (TJA) through the Veterans Affairs (VA) healthcare system experience poorer short-term outcomes than the general population. Given that many healthcare disparities were exacerbated during the COVID-19 pandemic, the aim of this study is to determine if veterans who underwent total knee arthroplasty (TKA) at a single VA medical center experienced poorer 30-day outcomes during versus before COVID-19. Methods A retrospective review of electronic medical records was conducted to identify patients who underwent primary TKA between July 2017 and November 2021 at a single VA medical center. A total of 208 patients (n=238 knees) were included in the study and divided into two cohorts: TKAs performed before COVID-19 (July 2017-March 2020, n=143 knees) and TKAs performed during COVID-19 (June 2020-November 2021, n=95 knees). Inpatient outcomes of interest included length of stay (LOS), pain, opioid use, and physical therapy (PT) attendance and performance. Outpatient outcomes of interest included 30-day complication, readmission, and mortality. Results Veterans in the COVID-19 group had a significantly shorter LOS (1.02 vs. 1.42 days) than the pre-pandemic group (p < 0.0001; d = -0.61, 95% CI: -0.87, -0.34). The COVID-19 group further demonstrated significantly greater PT attendance on postoperative day (POD) 0 (p = 0.0419; RR = 1.51, 95% CI: 0.98, 2.30), and reported less pain (p = 0.0185; d = -0.32, 95% CI: -0.58, -0.06), required fewer opioids (p < 0.0001; d = -0.59, 95% CI: -0.85, -0.32), and demonstrated superior PT performance on POD 1. There was no significant difference in 30-day complication, readmission, or mortality between groups. Conclusion In general, veterans who underwent TKA during COVID-19 had better 30-day outcomes than their pre-pandemic counterparts, which is consistent with trends observed in the general population.