The COVID-19 pandemic in Singapore: what does it mean for arthroplasty?

Figures & data

Figure 1. Weekly COVID-19 caseload at NCID/TTSH in comparison with cases nationwide.

Figure 2. Weekly comparison of total COVID-19 cases in Singapore (cumulative numbers), and the number of arthroplasties performed at TTSH.

Figure 3. Weekly comparison of number of new COVID-19 cases reported at TTSH/NCID and number of arthroplasties performed at TTSH.

Table 1. Demographic data on 47 arthroplasties

Demographic	mean (SD)	n
Female sex		35
Age	68 (8.1)
50–59		11
60–69		13
70–79		19
80–89		4
BMI	27 (5.5)
15–19		2
20–24		15
25–29		19
30–34		6
35–39		3
40–44		1
45–49		1
ASA Class:
1		1
2		32
3		14
Operation performed
TKR		32
THR		5
UKA		10
Indication
Osteoarthritis		39
Rheumatoid arthritis		2
Avascular necrosis		4
Revision surgery		2
Length of stay (days)	4.7 (2.3)
		29
5–10		16
		2

Table 2. Management of TTSH Arthroplasty Division against the World Health Organization (WHO) pandemic phases

WHO pandemic phase	Definition	Arthroplasty unit management goals	Arthroplasty caseload limit	Manpower contribution for pandemic	Elective cases selection criteria
Phase 3	Human infection (transmission in close contacts)	Assessment of stockpile and resources	100%	0%	All cases
Phase 4	Small cluster (< 25 cases lasting < 2 weeks)	Consider postponing future cases that are high risk (ASA 3 and above) or less severe	100%	0%	All cases
Phase 5	Large cluster (25–50 cases over 2–4 weeks) usage	Minimize use of intensive care beds/blood products Limit stockpile and manpower Severe arthropathy with limited mobility	50%	25%	ASA 1 or 2 patients Unlikely to require intensive care/blood products
Phase 6	Widespread in general population	Preserve intensive care beds/blood products Stockpile for pandemic usage solely	0%	25–75%	Cancel all cases
Post-peak period	Levels of infections have dropped below peak levels in most countries	Minimize use of intensive care beds/blood products Limit stockpile and manpower usage	25%	25%	Same as Phase 5