Pre-operative SARS-CoV-2 PCR test at between 48 and 72hours pre-operatively is safe for patients undergoing primary and revision hip and knee arthroplasty - a multicentre international study.

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.