A message for people waiting for joint replacement and other orthopaedic surgery

A message from the British Orthopaedic Association to people waiting for joint replacement and other orthopaedic surgery

Published 26 June 2020

We are acutely aware of the growing waiting lists that are affecting all planned surgery, but particularly orthopaedics (bone and joint treatment) which has the largest overall waiting list of any individual specialty. We have recently heard from people who are on waiting lists in very difficult situations and others who have been struggling to seek information about how long they might have to continue waiting. The message we have been hearing is one of concern, frustration and a lack of information. We know some hospitals have been actively supporting people waiting for surgery, but this advice has not been in place everywhere.

We want to reassure you that you have not been forgotten. As an organisation we are working to support the major national effort to restart healthcare services suspended during COVID-19, and deciding how to tackle the backlog safely. The British Orthopaedic Association (BOA) is a membership body for orthopaedic surgeons. We are not funded through the NHS, but we do work closely with the NHS and health bodies across the UK, and we are involved in work to restart and improve services following the pandemic. We are also working with the NHS and Government to explain what investment our area of healthcare needs.

We know that some people have received news about delay to their surgery and others will have been seeking an update and not received one. You may be in significant pain, or have difficulty with your mobility or living your day-to-day life. We understand this can have a huge impact and that clarity around the timing of your surgery is vital to you.

As services restart, the process and progress will vary across regions and hospitals. Although many areas have started to some extent, it will take time for services to fully re-start. One of the biggest challenges is reducing the risk of COVID-19 infection occurring in hospitals and other healthcare settings. We will need new ways of working including social distancing, increased cleaning, testing of staff and people coming for treatment and new working practices for staff. All this is vital to protect the safety and well-being of people having surgery and NHS staff. We need to start cautiously. We know how hard it can be during the period you are waiting for surgery and the current uncertainty is making that difficult.

Some things may be different for you compared to surgery in the past. Your surgeon is likely to ask you to follow new guidance in the weeks before surgery to help keep everyone safe, which may vary depending on the type of surgery you need and local arrangements. In many cases this could include a period of self-isolation with your household at home prior to surgery (e.g. for 14 days) as well as a swab test for COVID in the days before the surgery. Elective (planned) procedures will typically take place in a ‘green’ pathway of care that aims to be COVID-free and so measures like this are important.

You may wish to rethink having your surgery or ask more questions. In some cases people are already being contacted to ask whether they still want to go ahead with surgery at the current time, and we need you to help us understand how you feel about your surgery. Some patients are choosing not to go ahead, while others may have new questions about risks and precautions. There are some helpful resources listed below to help answer your questions, but we want you to know that when you are contacted as your surgery approaches, it’s fine to raise questions and discuss any concerns.

We encourage you to keep talking and to keep active. We need you to stay as healthy as you can both physically and mentally to be ready for your surgery. That will help you get the best results from your treatment in the long term. There are online tools and resources listed below to help you keep active, and to support your mental health. We have also provided some FAQs later in this document/on this page.

Further resources

(We will update this list in future as more resources become available.)

Keeping active and well

• For those awaiting hip and knee surgery, the Escape Pain App (for Android only) or online tool provides support to help you stay active at home. Access the support tools here. 
• For anyone seeking help to managing bone, joint or muscle pain at home, the Chartered Society of Physiotherapy has a collection of excellent resources to support you here. 
• Mental Health charity Mind has webpages about COVID and your wellbeing: https://www.mind.org.uk/information-support/coronavirus/coronavirus-and-your-wellbeing
• If you are struggling with your health (including both physical and mental health) while you wait for surgery, please consult your GP or orthopaedic consultant for advice.

Preparing for surgery

• FAQs for patients having an operation during the COVID-19 (coronavirus) pandemic, prepared by the Centre for Perioperative Care in collaboration with the Royal Colleges of Surgeons, Royal College of Nurses and other medical bodies available here.
• Information from the Royal College of Surgeons of England to help patients understand what's different about undergoing surgery during the pandemic can be found here.

Other groups and organisations

• Arthritis and COVID-19 - your questions answered (External resource from Versus Arthritis). Versus Arthritis also have a COVID ‘virtual assistant’ (COVA) or traditional helpline (https://www.versusarthritis.org/contact-us/)
• Patients Association: https://www.patients-association.org.uk/
• ARMA (Arthritis and Musculoskeletal Alliance) is an umbrella body bringing together patient organisations and professional bodies representing the breadth of musculoskeletal health. www.arma.uk.net/

FAQs:

Can you give me some idea how patients will be prioritised when services restart and how long I may need to wait?

As services do resume, there will be a careful consideration of how patients should be prioritised and the details may differ from one unit to another based on local factors. Overall, a large focus of this will be prioritisation of operations based on clinical urgency. During the pandemic, surgery has only been able to continue for the most urgent and emergency patients, such as those with major injuries, but many semi-urgent patients were not seen and so there is a backlog of these patients who have very time-critical conditions and whose care is being prioritised. We obviously fully recognise that everyone who is on the waiting list is there for an important reason, and needs that surgery. We are working with national bodies and charities for musculoskeletal disease to ensure that orthopaedic patients get the care they need as quickly as is possible.

We realise it may be very frustrating and disappointing if you started the waiting list with an idea of how long the wait would be in your area, but now have much less of an idea about how long you may be waiting. At the moment your local setting is likely to still be planning and prioritising and may not currently be able to give an idea of the likely wait. We expect timescales will become clearer over the coming weeks.

You may also like to be aware of a national prioritisation document, for which we contributed to the trauma and orthopaedic section, and which categorises procedures according to the urgency. You can find this online here.

Why is it taking time for services to resume?

As well as significant changes to practice to ensure safe operating, there are other factors that are affecting the restart of surgery: the continued diversion of resources to COVID-19 and other very urgent patients; increased staff absences due to shielding or caring for those shielding; and in some cases where operating theatres were repurposed during the pandemic and have not yet been returned. In addition, for surgery to go ahead this needs anaesthetists available and (for many procedures) physiotherapy rehab support afterwards - these other health care professionals have been heavily involved in the COVID response and in many cases continue to be redeployed.

For further info for orthopaedic patients relevant to COVID see here.