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

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 retur

Recommendations for resuming elective hip and knee arthroplasty in the setting of the SARS‑CoV‑2 pandemic: the European Hip Society and European Knee Associates Survey of Members

The COVID-19 pandemic has disrupted the health care system around the entire globe. A consensus is needed about resuming total hip and knee procedures. The European Hip Society (EHS) and the European Knee Association (EKA) formed a panel of experts that have produced a consensus statement on how the safe re-introduction of elective hip and knee arthroplasty should be undertaken. Methods A prospective online survey was done among members of EHS and EKA. The survey consisted of 27 questions. It includes basic information on demographics and details the participant’s agreement with each recommendation. The participant could choose among three options (agree, disagree, abstain). Recommendations focussed on pre-operative, perioperative, and post-operative handling of patients and precautions. Results A total of 681 arthroplasty surgeons participated in the survey, with 479 fully completing the survey. The participants were from 44 countries and 6 continents. Apart from adhering to National and Local Guidelines, the recommendations concerned how to make elective arthroplasty safe for patients and staf. Conclusion The survey has shown good-to-excellent agreement of the participants with regards to the statements made in the recommendations for the safe return to elective arthroplasty following the frst wave of the COVID-19 pandemi

Void growth based inter-granular ductile fracture in strain gradient polycrystalline plasticity

The precipitation hardened, high strength aerospace alloys (e.g. Al 7000 alloy series) suffer from loss of fracture toughness due to the heat treatment leading to intergranular ductile fracture. Depending on the quenching and aging processes, large precipitates at the grain boundaries with wide precipitate free zones might develop. Therefore the grain boundaries constitute a potential location for micro void formation and evolution under the effect of external loads. This is a common problem of such materials where there is considerable ductile intergranular fracture, which is normally attributed to the embrittlement effects of the environment in other type of alloys. In this context, for the modeling of such a degradation process, the current paper develops a physics based intergranular cracking model of polycrystalline materials where a strain gradient crystal plasticity model is combined with cohesive zone elements whose traction separation relation is based on the evolution of micro-voids at the grain boundaries. The framework successfully predicts the intergranular crack formation and propagation, taking into account different microstructural features, such as porosity, pore shape, grain orientation distribution, and grain boundary conditions