International Orthopaedics - 2026-03-24 - Journal Article
Quality of life before and during the COVID-19 pandemic for people undergoing hip, knee and shoulder arthroplasty-nationwide results from the Australian Orthopaedic Association National Joint Replacement Registry.
Gill SD, Page RS, Xu Q, Harris IA, Gill D, Ackerman IN
Topics
Key Takeaway
Despite statistically significant reductions in preoperative EQ-5D-5L scores during COVID-19, the adjusted mean difference was ≤0.03 points—not clinically meaningful—while THA and TKA patient satisfaction paradoxically increased by approximately 5 percentage points during the pandemic.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study used the Australian Orthopaedic Association National Joint Replacement Registry to compare EQ-5D-5L utility scores, Oxford Scores, pain, and satisfaction before (July 2018–March 2020) and during (March 2020–March 2023) the COVID-19 pandemic in primary THA, TKA, and RTSA patients. Preoperative and postoperative EQ-5D-5L scores were statistically lower during the pandemic for THA and TKA but the adjusted mean difference was ≤0.03 points. The odds of preoperative quality of life worse than dead increased significantly only for THA (OR 1.24–1.40), and satisfaction with surgical outcomes increased by approximately 5 percentage points for both THA and TKA during the pandemic.
Key Limitation
The study cannot determine whether patients who were indefinitely deferred or never rescheduled during the pandemic—the highest-risk group for QoL deterioration—are represented, as the registry only captures those who ultimately underwent surgery.
Original Abstract
BACKGROUND
The COVID-19 pandemic produced a substantial reduction in arthroplasties, which could have affected patient quality of life. This study investigated quality of life in Australians undergoing elective arthroplasty before and during the COVID-19 pandemic.
METHODS
Using data from the Australian Orthopaedic Association National Joint Replacement Registry, quality of life was assessed in patients before and six months after primary total hip arthroplasty (THA), total knee arthroplasty (TKA) and reverse total shoulder arthroplasty (RTSA) using the EQ-5D-5L instrument. Patients with an EQ-5D Utility score less than zero were considered to have a quality of life worse than dead. Secondary outcomes included Oxford Scores, joint-specific pain, patient perceived change, responder status and patient satisfaction. Quality of life was compared before (1 July 2018-10 March 2020) and during the pandemic (11 March 2020-10 March 2023) using linear or logistic regression models.
RESULTS
The analysis included preoperative data for more than 24,000 THA patients, 20,000 TKA patients and 1,100 RTSA patients. Compared to the pre-pandemic period, preoperative and postoperative quality of life significantly reduced during the pandemic for THA and TKA, but not by a meaningful amount (adjusted mean difference ≤ 0.03 points, p < 0.001). The likelihood of having quality of life worse than dead increased during the pandemic but was only significant for preoperative THA (ORs 1.24 to 1.40, p < 0.02). For secondary outcomes, joint-specific scores deteriorated, and joint pain increased to a small degree during the pandemic for THA and TKA (p < 0.05), but not for RTSA. The proportion of THA and TKA patients satisfied with their surgery outcome increased modestly during the pandemic by approximately five percentage points, compared to pre-pandemic.
CONCLUSION
The COVID-19 pandemic was not associated with a clinically meaningful deterioration in pre- or post-operative quality of life, on average, for patients undergoing THA, TKA or RTSA in Australia.