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INTRODUCTION: Patients undergoing lower limb arthroplasty who are SARS-CoV-2 positive at the time of surgery have a high-risk of mortality. The National Institute for Health and Clinical Care Excellence and the British Orthopaedic Association advise self-isolation for 14-days pre-operatively in patients at high-risk of adverse outcomes due to COVID-19. The aim of the study is to assess whether pre-operative PCR for SARS-CoV-2 could be performed at between 48 and-72 hours pre-operatively with specific advice about minimising the risk of SARS-CoV-2 restricted to between PCR and admission. METHODS: A multi-centre, international, observational cohort study of 1000 lower limb arthroplasty cases was performed. The dual primary outcomes were thirty-day conversion to SARS-CoV-2 positive and thirty-day SARS-CoV-2 mortality. Secondary outcomes included thirty-day SARS-CoV-2 morbidity. RESULTS: Of the 1000 cases, 935 (94%) had a PCR between 48 and 72-hours pre-operatively. All cases were admitted to, and had surgery through a COVID-free pathway. Primary knee arthroplasty was performed in 41% of cases, primary hip arthroplasty in 40%, revision knee arthroplasty in 11% and revision hip arthroplasty in 9%. Six-percent of operations were emergency operations. No cases of SARS-CoV-2 were identified within the first thirty-days. CONCLUSION: Pre-operative SARS-CoV-2 PCR test between 48 and 72-hours pre-operatively with advice about minimising the risk of SARS-CoV-2 restricted to between PCR and admission in conjunction with a COVID-free pathway is safe for patients undergoing primary and revision hip and knee arthroplasty. Pre-operative SARS-CoV-2 PCR test alone may be safe but further, adequately powered studies are required. This information is important for shared decision making with patients during the current pandemic.

Original publication




Journal article


J Arthroplasty

Publication Date



COVID-19, Morbidity, Mortality, Orthopaedic Surgery, Patient Outcomes, SARS-CoV-2