Orthopedic Risks and Recovery Considerations in Long COVID: A Narrative Review

The COVID-19 pandemic left a lasting imprint on orthopedic surgery, initially through widespread reductions in care delivery and subsequently through the complex challenges posed by Long COVID syndrome. Emerging literature describes Long COVID-related alterations in bone mineral density, delayed wound healing, prolonged inflammation, persistent chronic pain, and increased perioperative risks. Long COVID may adversely affect skeletal integrity through inflammatory, hypoxic, and angiotensin-converting enzyme 2-mediated pathways, potentially leading to bone loss and increased fracture susceptibility. Persistent inflammation, endothelial dysfunction, thrombotic tendency, and neurocognitive impairment may also increase perioperative vulnerability, while chronic musculoskeletal pain, reduced exercise capacity, and post-exertional malaise may complicate rehabilitation and functional recovery. Although orthopedic-specific evidence remains limited, the available findings suggest that Long COVID may represent an underrecognized risk modifier relevant to surgical planning and postoperative management. Greater awareness of these mechanisms may improve patient counseling, risk stratification, and rehabilitation strategies.