**Abstract**

During the COVID-19 pandemic, countries all over the world suffered from different kinds of service disruption or reduction in the field of orthopedics with or without lockdowns. The consequences include no restriction, partial disruption, overburden of medical services and complete shutdown of clinical practices. This chapter systematically reviews the current published literature on the global impact of COVID-19 on the field of orthopedics through multiple aspects, including educational impact, service volume impact, workload impact, personal practice change, psychological impact, and impact on orthopedic research. The rates of all surgeries and elective surgeries decreased by 15.6%–49.4% and 43.5–100%, respectively. The overall impact was attributable to the staff redeployment in response to the pandemic. Therefore, it is important to maintain a flexible allocation of manpower and more sufficient and reservable staffing measures in case of emergency staff shortages. Orthopedic surgeons are suggested to prepare proper preventive strategies and set up special equipment and places for regular telemedicine for virtual consultations or virtual teaching. It can be expected that the integration of the different experiences of global countries from the impact of COVID-19 may help us to face possible similar impacts in the future.

**Keywords:** COVID-19, pandemic, impact, lockdown, restriction, orthopedics, education, orthopedic service, clinical practice, workload, psychological effect

#### **1. Introduction**

The World Health Organization declared the 2019 coronavirus disease (COVID-19) as a worldwide pandemic on March 12, 2020. COVID-19 cases were first found in Wuhan, China, in December 2019 [1], possibly owing to the purchase, slaughtering, and consumption of exotic live animals in the Huanan seafood and animal market. COVID-19 is an infectious disease that can cause pneumonia. It has spread rapidly and has infected numerous individuals globally. A cumulative millions of cases have been confirmed, and thousands to millions of people have died of this disease, seriously impacting the global economy. Under this pandemic situation, the global orthopedics field was of course inevitably impacted and the impact was comprehensive.

The COVID-19 pandemic and related lockdowns or restrictions have greatly changed the daily lives of populations worldwide. It forced the healthcare system to undergo dramatic changes in response. A large number of COVID-19 cases in some regions have forced hospitals to reorganize their departments to have the capacity

to treat infected patients. Certain administrative or preventive epidemic strategies have caused many restrictions, such as separation of employees, reduction in the number of outpatient clinics, delayed or suspension of elective surgeries, and cancelation of non-emergency consultations or referrals to reduce the infection risk among patients and orthopedic staff.

In this chapter, the relevant publications from various countries in the world were sorted out and extracted their important research results based on different aspects, and provided readers with a comprehensive understanding of the impact of the pandemic. Because of the different infection situations in different countries, with different early responses, different infection control measures and different administrative management strategies, many of the results may not be suitable for a direct comparison. Therefore, this article mostly presented the results in an itemized, organized and narrative manner, avoiding unfair rankings among countries. All publications presenting comparable data, including reduction percentage of all surgeries and reduction percentage of elective surgery, were compared.
