Elective orthopaedic surgeries during COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic is attracting all the attention of the medical staff with the aim of saving lives; however, this has caused the cancellation of elective surgeries. In the case report by Kaidi et al [1], the authors share important information that helps other orthopaedic surgeons in the management of fractures in patients with active viral disease. On the other hand, this letter presents certain recommendations to resume elective orthopaedic procedures during this time of pandemic.

Owing to the cancellation of orthopaedic surgeries in the world, the European Hip Society and the European Knee Association established a consensus to reperform elective hip and knee arthroplasties safely. This study is based on a survey of 27 questions answered by 479 surgeons from 44 different countries, and it focuses on preoperative, perioperative, and postoperative care. The purpose of this tool is to evaluate the possible benefits and harms of a surgical procedure during this pandemic, considering the high risk of contagion and the high demand for medical supplies that are used to face the COVID-19 pandemic [2].

Otherwise, Rizkalla et al [3] establish an algorithm that classifies urgent arthroplasties and arthroplasties that can be postponed without problems. The decision to perform hip arthroplasty is based on the damage caused by not performing the procedure and the risk of contagion if the surgery is performed. Arthroplasty should be performed urgently in 2 settings: (1) acute fracture or periprosthetic joint infection and (2) the risk of COVID-19 infection is less than the damage from postponing surgery. On the other hand, arthroplasty should not be performed urgently if the risk of COVID-19 is greater than the damage from delayed surgery, and also, if the delay does not cause additional harm to the patient.

Likewise, a study in India presents an algorithm with strategies to resume orthopaedic and trauma surgeries during the pandemic. First, the patient must be classified as asymptomatic and symptomatic. Asymptomatic patients who have not traveled or had contact with infected people can undergo elective surgery. Asymptomatic patients with a travel or contact history should undergo a COVID-19 test. Patients negative for COVID-19 can undergo surgery, but in patients positive for COVID-19, the risks must be evaluated and established if surgery is essential. On the other hand, there are symptomatic patients confirmed by a COVID-19 test. If the individual is unstable, surgery should be postponed and the patient transferred to specialized care. But, if the individual is stable, the surgeon must establish the pros and cons of the procedure in this scenario [4].

Finally, the reintroduction of elective surgeries depends on several factors related to the availability of resources and medical staff, the current situation of the pandemic, and the patient's health status, among others. However, the final decision should be based on clinical and surgical criteria to avoid any complications.

Conflict of interests

The author declares there are no conflicts of interest.