Covid 19 Information

We at the Sunshine Coast Orthopaedic Clinic will take the highest level of care and precautions to minimise the threat to our patients and staff from COVID-19. Our office will stay open but will follow strict social distancing rules. Only patients themselves should attend the office. If an appointment is suitable for a Telehealth appointment then we will arrange that for you.

Patients over 70 years of age, or patients over 55 with chronic medical conditions should not attend unless absolutely necessary. Please call ahead and discuss your situation.

If you have ANY of the following please DO NOT visit the clinic, rather call ahead and we will arrange a telehealth consultation.

Fever, cough, sore throat, or shortness of breath.
OR
Had contact with someone diagnosed with suspected or having Novel Coronavirus.
OR
Have travelled internationally or domestically in the last 14 days.

The Federal Government has announced a shutdown of both private and public elective surgical services as of 1st April, 2020. Only Category 1 and urgent Category 2 cases can be performed at present. Most orthopaedic procedures will not satisfy these criteria. This can seem confusing as to what surgeries actually fit these Categories.

Please read below The Australian Knee Society Guidelines and the Australian Arthroplasty Society Guidelines to help clarify which cases apply.

The reasons to limit elective surgery are to limit the use of resources that may be needed in the front line to combat COVID-19 (including staff, nurses and doctors as they too may contract the virus) and to avoid exposure of often elderly orthopaedic patients whilst in hospital. Orthopaedic surgery typically needs extensive rehab/physiotherapy in the community after surgery that may be very difficult and also exposes the recovering patient to the community. As more of the community is colonised with COVID-19, there will become an unacceptable risk of transmitting the virus to staff, especially anaesthetic staff, who are at high risk because they are intimately involved in the patient’s airway where the virus resides.

The Australian Knee Society Guidelines

27th March 2020

In light of the Covid-19 pandemic and the unprecedented forthcoming strain on health resources the Australian Knee Society has listed knee surgical procedures below to assist with decision making.
The society encourages surgeons to obtain a documented independent peer opinion before scheduling surgery for Urgent Category 2 and should not perform surgery on non-urgent category 2 or category 3 patients.

Category One

  • Acutely infected Total Knee Replacement
  • Acute septic arthritis or other knee or bony sepsis requiring surgical drainage or debridement
  • Open fractures of femur, patella or tibia
  • Significantly displaced fractures with likely a clearly suboptimal outcome with non-surgical management
  • Knee dislocations that are irreducible, unable to be stabilized in a splint or associated with vascular injury
  • Infected pre-patella bursa not resolving with non-operative management
  • Malignant tumours around the knee
  • Quadriceps or patellar tendon rupture
  • Peri prosthetic fracture and/or broken implants

Urgent Category Two

  • Painful acutely locked knee due to loose body, detached OCD or obstructive meniscal tear
  • ACL Reconstruction with locked knee secondary to obstructive repairable meniscal tear
  • Chronically infected painful Total Knee Replacement threatening to progress to systemic sepsis

Non-Urgent Category Two and Category Three

  • Primary Knee arthroplasty
  • Revision Knee arthroplasty, except as above
  • ACL Reconstruction with intact meniscus or undisplaced meniscus tears
  • Arthroscopy, except as above
  • Proximal Tibial or Distal Femoral Osteotomy
  • Patellofemoral stabilization

This list is not exhaustive and in the situation where there is doubt, the AKS executive advises surgeons to obtain the opinion of a peer before scheduling surgery.
The situation is changing rapidly and these recommendations will be updated as required.

President
Christopher Vertullo

Secretary
Myles Coolican

Arthroplasty Society of Australia

27 March 2020

ASA position statement on surgery during the COVID-19 pandemic

The Arthroplasty Society of Australia strongly supports the position taken by the Australian Orthopaedic Association and the Royal Australasian College of Surgeons with regard to the performance of all non-essential surgery.

Delaying lower-limb arthroplasty surgery will result in a prolongation of disability; however, this must be balanced against the risk of surgery at this particular time. Exposing patients, medical staff, and other ancilliary hospital staff to the risk of serious illness and the possibility of quarantine at a crucial time is a real concern. Medical manpower must be preserved to prepare for the increasing workload of the pandemic. PPE, drugs and devices used to manage COVID-19 must be preserved.

Non-operative treatment should be considered where possible and wherever possible managed in the ambulatory setting or the emergency department, without admission to hospital.

Arthroplasty surgery should only be considered after appropriate peer review for these urgent conditions:

1. Acute deep infections
2. Periprosthetic fracture requiring surgery
3. Acute prosthetic dislocation, which should be managed in a closed fashion wherever possible
4. Fractured neck of femur
5. Chronic periprosthetic infection creating a threat to life or limb
6. Implant failure by breakage
7. Collapsed femoral head (AVN) resulting in severe intractable pain

Elective primary and revision hip and knee arthroplasty surgery should otherwise be cancelled or delayed during the COVID-19 crisis.
In all cases where surgery is to be performed according to the above guidelines, the specific risks of the case to staff and patients as well as the post-operative care in the specific hospital environment must be considered. Documented peer review of each proposed case is to be performed prior to surgery.

As this is an evolving situation this position statement will be reviewed and updated as required.

ASA Executive Committee
Bill Donnelly, President
Michael Solomon
Neil Bergman
Jonathan Mulford
Stephen McMahon