Reopening of elective total joint replacement surgery in a high-volume single-specialty hospital within a COVID-19 epicenter

Background: The coronavirus disease (COVID-19) pandemic has created significant change globally in healthcare systems. With the recommendation to stop elective surgery, healthcare systems incurred significant financial losses. As the initial surge begins to decline, hospitals and surgery centers are devising plans to resume elective cases. Therefore, the aim of this study is to describe an approach to resuming elective surgery for total joint replacement at our single-specialty, orthopaedic-only institution. Methods: With our multidisciplinary team, our hospital created an approach to resume elective surgery for total joint replacement under the COVID-19 pandemic conditions and state regulations. We describe our steps and processes to remain a COVID-19 negative institution. Results: Through our approach, our orthopaedic-only specialty institution was able to return to elective total joint arthroplasty procedures at significant volume during the pandemic, and, to date, has remained COVID-19 negative through these efforts. Conclusions: This manuscript aims to summarize an approach to the resumption of elective surgery focusing on four main areas of care: (I) preoperative screening and care, (II) operative care, (III) immediate post-operative care, and (IV) inpatient concerns. Our example may serve as a basic model which can be used as a template and customized to meet the specific needs and restrictions of other institutions as they work through returning to baseline.