Understanding patients' emotional well-being, perceptions and concerns during an unprecedented deferment of arthroplasty: an Italian qualitative study

Objectives: Nearly 40 000 Italian patients had their arthroplasty postponed between March and May 2020 (lockdown period) and experienced a period of several months without knowing when surgeries would resume. The hypothesis was that such conditions caused changes in perceived well-being and quality of life. The study aimed to explore the feelings, perceptions and concerns of orthopaedic patients in Italy during COVID-related arthroplasty rescheduling.

Design: The study designed by an interdisciplinary research group, used a qualitative methodology based on thematic analysis of semi-structured interviews.

Setting: Interviews were conducted by phone from August to November 2021.

Participants: A purposive sample of orthopaedic patients (from North, Centre and South of Italy), whose elective arthroplasty was delayed due to the COVID-related healthcare measures, was selected. Patients who opted for further voluntary deferment were included. Participants were mainly recruited through orthopaedic surgeons.

Results: We conducted and analysed 26 interviews (12 males and 14 females; age range 50-85 years). We identified six themes describing negative feelings, deterioration of quality of life, resources behind coping strategies associated with surgery postponement and lockdowns. A psychosocial phenomenon we called the 'lockdown paradox' was detected. It was induced by the general condition of isolation at home that made orthopaedic patients share restricted mobility with all the people in the country and, therefore, suffer less.

Conclusions: Arthroplasty suspension in the context of anti-COVID measures had implications on emotional well-being and perceived quality of life. Deterioration appeared mitigated by inner resources, favourable living conditions and, in some cases, by the psychosocial phenomenon, not detected in other studies, of the 'lockdown paradox' associated with mobility and autonomy restrictions shared by the whole community. Future studies are needed to investigate predictors of negative feelings and deterioration of quality of life in patients experiencing sudden major surgery delays.