Orthopaedic Surgery and Cortisone Injections during the COVID-19 Pandemic and with COVID Vaccination

As everyone is aware there has been massive disruption of normal medical services during the COVID pandemic, because NHS resources have been prioritized to look after people suffering from COVID, and because of concerns about the risks to patients from COVID if they have a surgical procedure or cortisone injection.

During the first wave in Spring 2020 all non-urgent elective Orthopaedic surgery in the NHS and private sector was stopped. Once it re-started in the Summer there were significant changes in how things were done. Patients were risk assessed for the risk to them of contracting COVID and having an operation, which took into account their age and general health and how major the planned surgery was. All patients had a COVID swab 3 days or so before admission and were asked to isolate for either 2 weeks or 3 days before their admission to minimise the risk of them being infected with COVID when they had their operation. Elective Orthopaedic surgery was done in “green theatres” where only swabbed and isolated patients were treated and all the staff were regular tested for COVID. Now that vaccines are available, all the staff in the NHS and private hospitals have been offered the vaccine. The latest data suggests that this significantly reduces the risk of transmitting the virus making it even safer for patients to be treated I hospital.

When the pandemic began there was advice to avoid treating patients with steroid (cortisone) injections because steroids diminish our immune response. The data on which this advice was based referred to patients being given large doses into a muscle. Numerous musculoskeletal conditions are treated with low dose steroid injections into a joint or soft tissue area and the effect that this has on a patient’s immune system and therefore increased risk of contracting COVID is very small.

COVID vaccination is now being offered to increasing numbers of the population. The advice from organizations such as the Royal College of Surgeons and British Orthopaedic Association is that patients should not delay or decline the offer of having the vaccine because they are having planned surgery. It is recommended that there should be at least a week between having the vaccine and having an operation, but purely because some people get a temperature after having the vaccine and it might make it difficult to know if a patient had a post-operative temperature whether this was a sign of a wound infection or because of the vaccine. At the moment the requirements to have a swab and to self-isolate prior to an operation still apply even for patients who have had the vaccine, but of course this may change over the coming months.

The advice regarding steroid injections is that there should be a 2 week interval between having the vaccine and having a steroid injection because the steroid might reduce the immune response to the vaccine and make it less effective.

Mr JAMES EDWARD NICHOLL

Consultant Orthopaedic Hand, Wrist and Elbow surgery MBBS FRCS (Tr.& Orth.)