Disruption of Arthroplasty Practice in an Orthopedic Center in Northern Italy During the Coronavirus Disease 2019 Pandemic

Abstract

Background: The Coronavirus disease 2019 (COVID-19) outbreak has put strain on many healthcare systems around the world, with important consequences. The aim of this paper is to describe the impact of the COVID-19 pandemic on hip and knee arthroplasties in an Italian high-volume orthopedic center, located in the region of the country first and worst affected by the Coronavirus. Methods: Data from an institutional database were retrospectively analyzed to obtain the number of hip and knee arthroplasties performed from February 24 to April 10 2020. The figures were compared with those of the same 7-week period of the last year (2019). Results: The number of hip and knee arthroplasties showed a decrease from 706 in the same period of 2019 to 166 (76.5% less) in the current year. In 2019, a mean of 101 ± 9 hip and knee arthroplasties were performed per week compared with a mean of 24 ± 34 in 2020. Ten patients tested positive for SARS-CoV2 during their hospital stay. Two of these patients died after a regular postoperative period after developing unexpectedly COVID-19 during rehabilitation. The mortality in the 7-week period of the current year was 1.2% compared with 0% in 2019. Conclusion:The outbreak of COVID-19 had a considerable effect in our center on the number of hip and knee arthroplasties that rapidly decreased to 0 in parallel to the worsening of the situation in the country. Efforts will be soon requested because our practice is going to deal with the after-effects of the pandemic in the near future.

A look at the global impact of SARS CoV-2 on orthopedic services

“…Nine centers reported the number of elective orthopedic procedures performed both before and during the COVID-19 pandemic. 9 , 10 , 16 , 17 , 20 , 29 , 36 , 38 , 39 Cumulatively, the number of elective surgeries decreased by 80% (2013/17400, 0.20, CI: 0.12 to 0.29) ( Fig. 2 ).…”

Operating room efficiency and timing during coronavirus disease 2019 outbreak in a referral orthopaedic hospital in Northern Italy

“…This period has been featured by a dramatic decrease in the surgical activity volume with the number of trauma cases become prominent [4][5][6][7][8]. Trauma cases were mostly represented by femoral neck fractures mainly in elderly patients due to falls in the domestic environment.…”

“…During the pandemic, the entire elective surgery activity has been stopped. Galeazzi Orthopaedic Institute was chosen by the Regional Health Authorities as a hub hospital for both orthopaedics and minor trauma surgery [4]. Patients from surrounding hospitals were redirected to our centre.…”

COVID-19. An update for orthopedic surgeons

“…With the risks posed by shortage of Personal Protective Equipment (PPE) [13][14][15] non-traditional solutions were developed such as 3D printed face shields, reusable gowns, and protocols for the re-use of PPE [18]. Moreover, the sudden overload of healthcare systems mandated institution of new hospitals as well as changing the bed capacity to increase respiratory care beds; this was coupled with initial reduction and later cancelation of all elective procedures in order to save the available resources and limit spread of the virus [19][20][21][22][23][24][25][26][27]. In the midst of this crisis, the orthopedic surgeon was surely affected: from de-specialization and serving on the frontline, to upgrades from fellow to faculty and reassignment of residents to clinical care rotations [18][19][20][21][22][23][24][25][26][27][28].…”