header advert
You currently have no access to view or download this content. Please log in with your institutional or personal account if you should have access to through either of these
The Bone & Joint Journal Logo

Receive monthly Table of Contents alerts from The Bone & Joint Journal

Comprehensive article alerts can be set up and managed through your account settings

View my account settings

Get Access locked padlock


The rate of COVID-19 and associated mortality after elective hip and knee arthroplasty prior to cessation of elective services in UK

A multicentre study conducted during March 2020

Download PDF



The primary aim was to assess the rate of postoperative COVID-19 following hip and knee arthroplasty performed in March 2020 in the UK. The secondary aims were to assess whether there were clinical factors associated with COVID-19 status, the mortality rate of patients with COVID-19, and the rate of potential COVID-19 in patients not presenting to healthcare services.


A multicentre retrospective study was conducted of patients undergoing hip or knee arthroplasty during the first wave of the COVID-19 pandemic (1 March 2020 to 31 March 2020) with a minimum of 60 days follow-up. Patient demographics, American Society of Anesthesiologists grade, procedure type, primary or revision, length of stay (LOS), COVID-19 test status, and postoperative mortality were recorded. A subgroup of patients (n = 211) who had not presented to healthcare services after discharge were contacted and questioned as to whether they had symptoms of COVID-19.


Five (0.5%) of 1,073 patients who underwent hip or knee arthroplasty tested positive for SARS-CoV-2 postoperatively. When adjusting for confounding factors, increasing LOS (p = 0.022) was the only significant factor associated with developing COVID-19 following surgery and a stay greater than three days was a reliable predictor with an area under the curve of 81% (p = 0.018). There were three (0.3%) deaths in the study cohort and the overall mortality rate attributable to COVID-19 was 0.09% (n = 1/1,073), with one (20%) of the five patients with COVID-19 dying postoperatively. Of the 211 patients contacted, two had symptoms within two to 14 days postoperatively with a positive predictive value of 31% and it was therefore estimated that one patient may have had undiagnosed COVID-19.


The rate of postoperative COVID-19 was 0.5% and may have been as high as 1% when accounting for those patients not presenting to healthcare services, which was similar to the estimated population prevalence during the study period. The overall mortality rate secondary to COVID-19 was low (0.09%), however the mortality rate for those patients developing COVID-19 was 20%.

Cite this article: Bone Joint J 2021;103-B(4):681–688.

Correspondence should be sent to Nicholas D Clement. E-mail:

IMPACT-Restart Collaborators: James Horton, Elspeth Murray (Larnakshire); Diana Arnold, Sankar Sripada (Tayside); Ian McLean, Mary McDermott (Forth Valley); Andrew T Johnston (Grampian); Anthony Gibson, Mhairi Clark (Ayrshire & Arran); Susan Groom, Michael Kelly (Glasgow (South)); Paul J. Jenkins (Glasgow (North)); Shariff Hazirika (Clyde); Phil Walmsley (Fife); Nicholas J. Holloway, Nicholas E. Ohly, Jon V. Clarke (Golden Jubilee National Hospital); Catherine Warwick (Dumfries & Galloway); Graham F. Dall (Borders); Iuliana Kanya (Highlands); Nick D. Clement, Andrew Hall, Andrew D. Duckworth, James T. Patton, Matthew Moran, Chloe E. H. Scott, Robyn F. Patton, Gavin J. MacPherson (Lothian); Saeed Zaki, Richard Galloway (Western Isles); Ben Ollivere, Jessica Nightingale (Nottingham); Nardeen Kader, Dieary Kader, Irrum Afzal, Richard E. Field (South West London Elective Orthopaeic Centre); Sam Oussedik, Valeria Pintar, Justin S. Chang (University College London Hospital); Amy Shenfine, Mike Reed, Dominic Inman (Northumbria); Kelly Atkinson, Stuart Watson, Karen Smith, David Deehan (Newcastle).

For access options please click here