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

Knee Surg Sports Traumatol Arthrosc. 2020 Sep;28(9):2730-2746. doi: 10.1007/s00167-020-06233-9. Epub 2020 Aug 25.


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; Hip; Knee; Primary joint arthroplasty; Recommendations; Safety.

Publication types

  • Practice Guideline

MeSH terms

  • Anthropology, Medical
  • Arthroplasty, Replacement, Hip*
  • Arthroplasty, Replacement, Knee*
  • Betacoronavirus
  • COVID-19
  • Consensus
  • Coronavirus Infections / epidemiology*
  • Delivery of Health Care / methods
  • Disinfection / methods
  • Disinfection / standards
  • Elective Surgical Procedures / methods*
  • Europe
  • Hospital Units / organization & administration
  • Hospital Units / standards
  • Humans
  • Operating Rooms / organization & administration
  • Operating Rooms / standards
  • Orthopedic Procedures
  • Orthopedics
  • Pandemics
  • Personal Protective Equipment
  • Pneumonia, Viral / epidemiology*
  • SARS-CoV-2
  • Surveys and Questionnaires