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Prakash Chandran: This COVID-19 podcast was recorded on February 22nd, 2021.

While having surgery three can cause a lot of anxiety, having it in the middle of a pandemic can make that anxiety even worse. With so many unknowns during this difficult time, it's necessary to understand what precautions are being taken to keep patients safe and why it's important to be proactive about care. We're going to talk about it with Dr. Sam Sydney, an orthopedic surgeon for the Orthopaedic Associates of Central Maryland.

This is A Bone to Fix, the orthopedic podcast from the Orthopaedic Associates of Central Maryland. My name is Prakash Chandran. So first of all, Dr. Sydney, it is great to have you here today. You know, we are still in the midst of this pandemic, but we are approaching the tail end. And I know a lot of people that might need orthopedic surgery are thinking, why don't I just wait? So maybe start by answering the question of, is it safe to wait to have your orthopedic surgery done?

Dr. Sam Sydney: Our musculoskeletal system does not understand the pandemic and certain musculoskeletal ailments tend to progress even during a pandemic. What we have seen is that some of the trauma that we normally would see simply because we are now more restricted, our activity is somewhat decreased, but other problems with our wear and tear issues, chronic pain issues, do not seem to take a break just because we're in a pandemic.

Prakash Chandran: That completely makes sense to me. But there's going to be some potential surgeries out there that are considered elective surgeries. So can you maybe speak to some of those?

Dr. Sam Sydney: You know, what I would consider elective procedures are procedures that don't require emergent care. That means you don't have to go to an emergency room or urgent care center. Things that you've been dealing with or might've become more problematic during this pandemic. And you need to figure out what does it take to get this problem behind you?

Prakash Chandran: Yes, completely. But it's funny, you know, I have a friend who has hurt their leg. And they've kind of been prolonging going in because their thought is, "Hey, you know what? If I've dealt with it for this long, it can wait a little bit longer." But it seems like they should be going or people like them should be talking to a professional to really see what is elective and what is not, isn't that correct?

Dr. Sam Sydney: I believe that everybody owes it to themselves to not rely completely on internet research, but to at least get the opinion of a healthcare professional as to whether it is wise and safe to wait on having definitive care of whatever the problem is.

Prakash Chandran: Okay. So let's say that it's decided that you do need to go in, there's still some fear or apprehension around needing to go in and potentially contracting COVID-19. So maybe let's talk a little bit about some of the precautions that have been put in place to ensure that patients are protected when they come in.

Dr. Sam Sydney: Yes. I think the apprehension during this pandemic is very normal. What you should know is that in the facilities that our surgeons operate, all the caregivers have had the vaccine. They also undergo daily screening and it's usually a questionnaire with rapid testing if something should be awry on the questionnaire. So you can rest assure that the staff taking care of you is as protected in terms of your safety as possible.

Now, what should you do as a patient? You want to view this to have the least amount of contact with people as you can. Hence, you want to be in a facility for as short a time as possible and then get to a home environment if that is a safe environment to be.

Prakash Chandran: And how long leading up to the surgery do they need to really make sure that they limit their contact with others?

Dr. Sam Sydney: Each diagnosis has its own variable time limit. I think from a patient standpoint, if you have a COVID test, you should sort of self-quarantine until your procedure. You should try to get the vaccine if you're in one of the groups that qualifies for the vaccine, that would add another degree of protection. But if the underlying problem necessitates having surgical intervention or some other intervention sooner than later, it's always a weighing the risks versus the benefit.

Prakash Chandran: So let's talk about the surgery itself and the rehabilitation process. Just given that so much has changed in this past year, have things changed around how you perform the surgeries and how people rehabilitate afterwards?

Dr. Sam Sydney: I think they have. What we have seen is a significant rise in outpatient surgeries. I am predominantly an adult reconstruction surgeon. So for example, total hip and total knee replacements in the right patients are being done as an outpatient or, at the most, an overnight stay in the hospital.

In the past, these oftentimes would necessitate a few day length of stay in the hospital. This has actually been one of the few positives of this pandemic in the sense that we have found that patients actually seem to do a lot better. They're much more engaged in their wellbeing and recovery and are much more meticulous in their own personal hygiene and care.

Prakash Chandran: So building on that a little bit, you talked about the fact that there is more outpatient and that's kind of been an evolution for orthopedic surgery. Looking into the future, just given everything that you've learned during this pandemic, how do you see the future of orthopedic surgery in general?

Dr. Sam Sydney: Yes. We've seen the growth of telehealth medicine. That means with fewer face-to-face encounters, a number of activities can be performed via telehealth or a video chat. We can assess a patient's progress in terms of their prehab. What do I mean by prehab? Once a patient knows they need to have something done, usually we prescribe a set of exercises or modalities to gain strength or gain mobility before surgery. This would be something that could be handled on a telehealth visit with very minimal interaction with physical therapists and a lot to be done by the patient on their own.

Prakash Chandran: So just as we start to close here, do you have any other parting words of wisdom that you can share with people, especially those that might still be a little bit scared to come in to get their surgery?

Dr. Sam Sydney: Yes. I think each person needs to weigh whatever particular ailment they're suffering. If it's something that's been longstanding, it can possibly wait until after we have a better handle on this pandemic and it's hopefully in our rear view mirror. But there are certain things that as a condition deteriorates without correct intervention in a timely fashion, the ultimate result might not be the desirable one, which we always hope for an excellent result.

So another way of saying is that delaying can really have a longterm consequence, but each patient needs to weigh their risk-benefit tolerance. Some of us have significant comorbid problems that would make us more at risk. Others with the right precautions would be perfectly fine to have whatever intervention is needed.

Prakash Chandran: So one final question. You've obviously seen a lot of patients during this pandemic and even potentially patients that might have waited a little bit too long. Are there common ailments or consequences that you have seen from people that have waited maybe a little bit too long to come in?

Dr. Sam Sydney: Yes. During this pandemic, we're noticing this significant restriction in outdoor activities. So for lower extremity chronic problems, whether it's hip or knee arthritis, we're noticing that patients are becoming deconditioned or another way of saying, out of shape much more so than they would in the past, simply because activities have been restricted.

If this goes on too far and for too long after the surgical intervention or surgical correction of a problem, the rehabilitation might be incomplete or never reaching the level that the patients would have hoped. Another way of saying this is in rotator cuff or shoulder problems, if one is dealing with a tear, if one waits too long, the tear can get bigger or the muscle can atrophy, thereby compromising the ultimate repair and outcome of what will be otherwise a fairly good outcome.

Prakash Chandran: So just in closing, what I've taken away from this conversation is that, you know, your pain and orthopedic problems don't necessarily stop because of the pandemic. So it's really important to assess your individual situation to evaluate those risks that you were referring to earlier. And then really, if you have something you've been prolonging getting looked at, to go in, because there's been a lot of precautions that have been taken to keep you safe during this time. Isn't that right?

Dr. Sam Sydney: That is correct. Or at least touch bases with your orthopedic professional so they can give you the best advice and advise whether waiting is going to have a significant negative effect or whether it can stand to be put off for a while.

Prakash Chandran: Well, Dr. Sydney, that is great advice. Thank you so much for your time today. That's Dr. Sam Sydney, an orthopedic surgeon for the Orthopaedic Associates of Central Maryland. For more information, you can head to www.mdbonedocs.com.

If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks for listening to this episode of A Bone to Fix. My name is Prakash Chandran, and we'll talk next time.