Resuming elective hip and knee arthroplasty after the first phase of the SARS-CoV-2 pandemic: the European Hip Society a

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Resuming elective hip and knee arthroplasty after the first phase of the SARS‑CoV‑2 pandemic: the European Hip Society and European Knee Associates recommendations N. P. Kort1 · E. Gómez Barrena2 · M. Bédard3 · S. Donell4 · J.‑A. Epinette5 · B. Gomberg6 · M. T. Hirschmann7,8 · P. Indelli9,10 · Ismail Khosravi11 · T. Karachalios12 · M. C. Liebensteiner11 · B. Stuyts13 · R. Tandogan14 · B. Violante15 · L. Zagra16 · M. Thaler11 Received: 11 July 2020 / Accepted: 10 August 2020 © The Author(s) 2020

Abstract Purpose  The Covid-19 pandemic has disrupted health care systems all over the world. Elective surgical procedures have been postponed and/or cancelled. Consensus is, therefore, required related to the factors that need to be in place before elective surgery, including hip and knee replacement surgery, which is restarted. Entirely new pathways and protocols need to be worked out. Methods  A panel of experts from the European Hip Society and European Knee Association have agreed to a consensus statement on how to reintroduce elective arthroplasty surgery safely. The recommendations are based on the best available evidence and have been validated in a separate survey. Results  The guidelines are based on five themes: modification and/or reorganisation of hospital wards. Restrictions on orthopaedic wards and in operation suite(s). Additional disinfection of the environment. The role of ultra-clean operation theatres. Personal protective equipment enhancement. Conclusion  Apart from the following national and local guidance, protocols need to be put in place in the patient pathway for primary arthroplasty to allow for a safe return. Keywords  COVID-19 · Primary joint arthroplasty · Hip · Knee · Safety · Recommendations

* S. Donell [email protected] 1

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Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA

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International Committee American Academy Hip and Knee Surgeons (AAHKS), Rosemont, IL, USA

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Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria

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Orthopaedic Department, University General Hospital of Larissa, School of Health Sciences, Faculty of Medicine, University of Thessaly, Volos, Greece



CortoClinics, Schijndel, The Netherlands

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Department of Orthopaedic Surgery and Traumatology, Hospital La Paz, Universidad Autónoma de Madrid, Madrid, Spain

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Département de Chirurgie Orthopédique, CHU de Québec-Université Laval, Quebec City, QC, Canada

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Norwich Medical School, University of East Anglia, Norwich, UK

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Center for Research and Documentation in Arthroplasty, Lille, France

Department of Orthopedic Surgery and Traumatology, GZA Hospitals, Antwerp, Belgium

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Ortoklinik and Cankaya Orthopedics, Ankara, Turkey

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Orthopaedic Department, Istituto Clinico Sant’Ambrogio IRCCS Galeazzi, Milan, Italy

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Hip Department IRCCS Istituto Ortopedico Galeazzi, Milan, Italy



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OA Centers for Orthopaedics, Portland, ME, USA

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Department of Orthopaedic Surgery and Traumatolog