Coronavirus disease 2019 pandemic: should we delay cartilage regenerative procedures and accept the consequences, or can
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LETTER TO THE EDITOR
Coronavirus disease 2019 pandemic: should we delay cartilage regenerative procedures and accept the consequences, or can we find a new normality? Francesca Vannini 1
&
Antonio Mazzotti 1 & Niccolò Stefanini 1 & Cesare Faldini 1,2
Received: 29 June 2020 / Accepted: 16 July 2020 # SICOT aisbl 2020
Abstract The COVID-19 pandemic changed elective surgery routine. During the initial spread of the novel coronavirus, elective surgery has been stopped and only emergency and trauma and oncologic procedures were allowed. Following the decrease of the contagion curve, elective surgery is slowly being recovered. The hospitals should create a pre-hospitalization path to identify possible infected patient and further postpone surgery. In this setting, cartilage repair surgery should not be neglected, because this could potentially lead to an increase of patients needing major joint replacement surgery.
Dear Editor The COVID-19 pandemic, caused by the novel coronavirus (SARS-CoV-2), had a strong negative impact on international communities. Emergency departments and ICUs have been under a major stress and in orthopaedic surgery, only emergencies and trauma-related or oncologic procedures were allowed [1]. Orthopaedic departments underwent a strong limitation, since elective surgery represents approximately 47% of orthopaedic expenditures. With the virus spread being progressively controlled in Italy, the healthcare system is heading towards a progressive return to normal activity. There are several key aspects to be considered to return to elective procedures in a safe environment. In a large orthopaedic facility, such as the Rizzoli Institute, with an emergency department, the maintenance of a specific pathway is mandatory to treat potentially infected patients: trauma patients for whom surgery is mandatory, who are isolated until the swab, executed at the time of the admission, whose results are negative. If positive, the isolation is maintained in a dedicated department and surgery is performed in a * Francesca Vannini [email protected] 1
1st Orthopaedic and Traumatologic Clinic, IRCCS - Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna 40136, Italy
2
Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, Bologna, Emilia-Romagna, Italy
dedicated operating room, with assigned access, staff and instrumentation. While resuming elective procedures, preference has been given to traditionally considered “major” surgery, such as spinal procedures or primary and revision large joint replacements. Cartilage regenerative procedures and even orthobiologics were among the suspended procedures; still, a delay in treatment of arthritis-promoting lesions could result in an increased number of patients who will need joint replacement in the future, with potential long-term influence on quality of life [2]. To effectively and safely return to cartilage repair surgery, the entire course of treatment should be structured to either avoid risk of infection or make it of the lowest
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