Guidelines for Restarting Elective Hip and Knee Arthroplasty Post SARS-CoV-2 Initial Phase

Overview

The European Hip Society and European Knee Associates provide consensus recommendations for safely resuming elective hip and knee arthroplasty after the initial SARS-CoV-2 pandemic phase. Key considerations include patient selection, preoperative screening, hospital reorganization, anesthesia protocols, and postoperative care to minimize infection risk and optimize outcomes.

Background

The SARS-CoV-2 pandemic caused a significant reduction in elective hip and knee arthroplasty surgeries across Europe, impacting patients with severe osteoarthritis by delaying treatment and increasing opioid use and readmission rates. Restarting elective procedures requires careful planning to ensure patient and staff safety while addressing the backlog of cases. Existing guidelines were insufficient, prompting expert consensus to establish evidence-based recommendations for the safe reintroduction of these surgeries.

Data Highlights

An April 2020 survey by EHS and EKA members confirmed the pandemic's impact on arthroplasty volumes. Delays in surgery have been linked to poorer clinical outcomes, increased opioid consumption, and higher readmission rates. The consensus report addresses multiple clinical questions regarding timing, patient triage, anesthesia, hospital logistics, and postoperative management to guide safe resumption of elective arthroplasty.

Key Findings

• Elective hip and knee arthroplasty should resume only when local SARS-CoV-2 infection rates are controlled and hospital resources are adequate.
• New triage and patient selection criteria are recommended to prioritize cases based on severity, risk factors, and urgency.
• Preoperative clinical and laboratory screening, including SARS-CoV-2 testing, is essential with defined timelines; positive tests require surgery postponement.
• Hospital wards should be reorganized to separate elective from trauma cases, reduce patient density, and implement strict infection control measures.
• Spinal anesthesia is preferred to reduce aerosol generation; patients consenting to regional anesthesia should be prioritized.
• Postoperative care should minimize face-to-face contact through telemedicine and consider home care or community nursing to reduce exposure risk.

Clinical Implications

Clinicians should implement rigorous preoperative screening protocols and prioritize patients based on clinical urgency and COVID-19 risk. Hospitals must adapt infrastructure and workflows to separate elective arthroplasty patients from trauma and COVID-19 cases, ensuring adequate PPE use and environmental disinfection. Enhanced recovery and outpatient protocols may reduce hospital stay and exposure, while telemedicine can support postoperative follow-up safely.

Conclusion

The consensus guidelines from EHS and EKA provide a comprehensive framework to safely restart elective hip and knee arthroplasty amid ongoing SARS-CoV-2 challenges. Adhering to these recommendations can optimize patient outcomes while minimizing infection risks to patients and healthcare workers.

References

1. European Hip Society and European Knee Associates 2020 -- Guidelines for Restarting Elective Hip and Knee Arthroplasty Following the Initial Phase of the SARS-CoV-2 Pandemic