The presence of an artificial joint, or orthopedic implant, is common for millions who have undergone total joint replacement surgery. The emergence of the SARS-CoV-2 virus and the resulting COVID-19 pandemic raised immediate concerns about how this systemic illness might interact with foreign materials inside the body. The central question for those with a hip, knee, or other joint replacement is whether the virus or the resulting disease process poses a specific, direct threat to the implant itself. Understanding this relationship requires separating the temporary, generalized symptoms of the illness from the potential for rare, serious complications involving the hardware.
Acute COVID-19 and General Musculoskeletal Symptoms
A common feature of acute COVID-19 infection is generalized aches and pains throughout the body, regardless of whether a person has an artificial joint. Musculoskeletal symptoms like myalgia (muscle pain) and arthralgia (joint pain) are frequently reported, sometimes in over 50% of patients. These symptoms result from the body’s inflammatory response to the viral invasion, not the virus directly attacking the implant or surrounding tissue.
The systemic inflammation is driven by elevated levels of pro-inflammatory signaling molecules, known as cytokines, released as the immune system fights the virus. This phenomenon, sometimes referred to as a cytokine storm in severe cases, can cause widespread pain by affecting nerves and muscle tissue. The pain is temporary and subsides as the acute viral infection resolves. This generalized pain during the acute phase is distinct from the localized, persistent pain that would indicate an orthopedic complication like implant loosening or infection.
Risk of Periprosthetic Joint Infection Post-COVID
The most serious complication concerning artificial joints is a periprosthetic joint infection (PJI). Current medical consensus suggests that the SARS-CoV-2 virus itself does not directly infect the periprosthetic tissue surrounding the implant. The virus is primarily a respiratory pathogen, and direct viral colonization of the joint replacement interface is considered extremely rare.
The risk of PJI arises from the potential for a secondary bacterial infection carried through the bloodstream, a process called hematogenous spread. Any severe systemic infection, including severe bacterial pneumonia or sepsis that can sometimes accompany COVID-19, creates a risk of bacteria seeding the implant. This risk is highest in patients who are critically ill or who have undergone a total joint arthroplasty recently.
Studies indicate that patients diagnosed with COVID-19 in the immediate preoperative period (within two weeks of scheduled surgery) have a measurable increase in PJI risk compared to those without a recent infection. This heightened risk is thought to result from a transient state of immunosuppression and systemic inflammation. Therefore, the risk to the implant is indirect, stemming from the severity of the overall illness and the presence of bacterial co-infections, rather than the COVID-19 virus directly targeting the implant.
Indirect Systemic Complications Impacting Joint Function
Severe COVID-19 can lead to systemic complications that indirectly compromise the function and surrounding support of an artificial joint. The illness is associated with a hypercoagulable state, meaning the blood is more prone to clotting. This increases the risk of venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE).
For patients who have recently had joint replacement surgery, the risk of DVT and PE is already elevated, and a COVID-19 diagnosis can compound this risk dramatically. Studies show up to a four- to six-fold increase in the odds of these events. Severe illness often necessitates prolonged bed rest and hospitalization, which leads to muscle atrophy and joint stiffness. This enforced immobilization can reverse the functional gains made during initial post-operative rehabilitation.
Treatment for severe COVID-19 can also introduce risks. The use of high-dose corticosteroids, which are used for patients with respiratory compromise, is a known risk factor for developing osteonecrosis (bone death). Osteonecrosis most commonly affects the hip or knee and can compromise the underlying bone structure, potentially leading to the failure of a replacement that relies on that bone for support.
Long-Term Recovery and Rehabilitation Challenges
The long-term effects of COVID-19, often referred to as Long COVID or Post-Acute Sequelae of SARS-CoV-2 Infection (PASC), present unique challenges to the functional recovery of individuals with artificial joints. Persistent symptoms like profound fatigue, joint pain, and muscle weakness can linger for months after the acute infection has passed. This chronic physical impairment directly interferes with the patient’s ability to engage in structured physical therapy.
A successful outcome following joint replacement surgery depends on consistent rehabilitation to restore muscle strength and range of motion. When chronic fatigue and joint pain are present, the patient’s capacity to perform the necessary exercises is reduced. This can lead to persistent functional deficits, such as a reduced range of movement and continued reliance on mobility aids.
Patients recovering from severe COVID-19, especially those who experienced deconditioning during hospitalization, require an intensified and carefully monitored physical therapy regimen. The goal is to gradually rebuild the muscle mass lost during immobilization while managing the lingering systemic symptoms of Long COVID. Close collaboration between the orthopedic surgeon, rheumatologist, and physical therapist is necessary to ensure the artificial joint achieves its intended function despite the long-term impact of the viral illness.