Related Experiment Video
Updated: Dec 18, 2025
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Universal Testing for COVID-19 in Essential Orthopaedic Surgery Reveals a High Percentage of Asymptomatic Infections
Jordan A Gruskay1, Aleksey Dvorzhinskiy1, Maxwell A Konnaris1
1Department of Orthopaedic Surgery (J.A.G., A.D., D.G.L., A.P., C.J.D., and W.M.R.) and the HSS Research Institute (M.A.K., G.C.G., and C.L.M.), Hospital for Special Surgery, New York, NY.
Insights
Universal COVID-19 testing for orthopaedic surgery patients identified a high rate of asymptomatic infections. This highlights the need for widespread screening to prevent surgical setting transmission and manage patient risk.
Area of Science:
- Infectious Diseases
- Orthopaedic Surgery
- Public Health
Background:
- The COVID-19 pandemic poses challenges for healthcare institutions due to asymptomatic spread.
- Identifying infected individuals is crucial for preventing transmission to staff and patients.
- Resumption of elective orthopaedic surgery necessitates robust screening protocols.
Purpose of the Study:
- To report the outcomes of a universal COVID-19 testing protocol for orthopaedic surgery patients.
- To describe the postoperative course of asymptomatic COVID-19 positive patients.
Main Methods:
- Retrospective review of adult orthopaedic cases (March 25 - April 24, 2020).
- Initial screening via questionnaire, followed by universal nasopharyngeal swab real-time quantitative polymerase chain reaction (RT-PCR) testing for all admissions.
- Analysis of screening data, testing results, imaging, laboratory values, and postoperative complications.
Main Results:
- 99 patients underwent routine COVID-19 testing prior to orthopaedic surgery.
- 12.1% of patients tested positive; 58.3% of those were asymptomatic.
- Three asymptomatic patients experienced postoperative hypoxia, with two requiring intubation.
- The negative predictive value of symptom-based screening was 91.4%; chest radiography did not significantly improve this.
Conclusions:
- Universal COVID-19 testing in orthopaedic surgery admissions identified a significant number of asymptomatic infections.
- Asymptomatic patients pose a risk for postoperative complications.
- Findings have critical implications for the safe resumption of elective orthopaedic procedures.
Background:
The long incubation period and asymptomatic spread of COVID-19 present considerable challenges for health-care institutions. The identification of infected individuals is vital to prevent the spread of illness to staff and other patients as well as to identify those who may be at risk for disease-related complications. This is particularly relevant with the resumption of elective orthopaedic surgery around the world. We report the results of a universal testing protocol for COVID-19 in patients undergoing orthopaedic surgery during the coronavirus pandemic and to describe the postoperative course of asymptomatic patients who were positive for COVID-19.
Methods:
A retrospective review of adult operative cases between March 25, 2020, and April 24, 2020, at an orthopaedic specialty hospital in New York City was performed. Initially, a screening questionnaire consisting of relevant signs and symptoms (e.g., fever, cough, shortness of breath) or exposure dictated the need for nasopharyngeal swab real-time quantitative polymerase chain reaction (RT-PCR) testing for all admitted patients. An institutional policy change occurred on April 5, 2020, that indicated nasopharyngeal swab RT-PCR testing for all orthopaedic admissions. Screening and testing data for COVID-19 as well as relevant imaging, laboratory values, and postoperative complications were reviewed for all patients.
Results:
From April 5, 2020, to April 24, 2020, 99 patients underwent routine nasopharyngeal swab testing for COVID-19 prior to their planned orthopaedic surgical procedure. Of the 12.1% of patients who tested positive for COVID-19, 58.3% were asymptomatic. Three asymptomatic patients developed postoperative hypoxia, with 2 requiring intubation. The negative predictive value of using the signs and symptoms of disease to predict a negative test result was 91.4% (95% confidence interval [CI], 81.0% to 97.1%). Including a positive chest radiographic finding as a screening criterion did not improve the negative predictive value of screening (92.5% [95% CI, 81.8% to 97.9%]).
Conclusions:
A protocol for universal testing of all orthopaedic surgery admissions at 1 hospital in New York City during a 3-week period revealed a high rate of COVID-19 infections. Importantly, the majority of these patients were asymptomatic. Using chest radiography did not significantly improve the negative predictive value of screening. These results have important implications as hospitals anticipate the resumption of elective surgical procedures.
Level Of Evidence:
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
More Related Videos
03:42High-Speed Human Temporal Bone Sectioning for the Assessment of COVID-19-Associated Middle Ear Pathology
Published on: May 18, 2022
18:40Combined In vivo Optical and µCT Imaging to Monitor Infection, Inflammation, and Bone Anatomy in an Orthopaedic Implant Infection in Mice
Published on: October 16, 2014
