By: 5 May 2021
The impact of COVID-19: A case study

As the COVID-19 vaccine roll-out advances, people, governments and industries are contemplating and planning for the long journey back to normality.

Like all others in the medical field, the orthopaedic community is facing ongoing challenges and remains focused on limiting the possibility and extent of potential next “waves” in Europe.

Orthopaedics company, Zimmer Biomet, has for some time advocated for a more holistic view of musculoskeletal care. The company has encouraged the use of evidence-based care pathway management and process optimisation, including patient education, as an integral part of the relationship between the company, healthcare providers and patients.

The COVID-19 pandemic has emphasised the importance of this integrated approach. We spoke with Zimmer Biomet’s VP North Region, EMEA, Michael Green, pictured, about how clinics can benefit from a broader view of care in light of the pandemic and with Dr. Cristina Crisan Tran about how the company has maintained education throughout 2020 and into the new year.

To limit hospital-stay-related risks, length of stay (LOS) plays an important role, explains Mr. Green.

“Over a number of years, we have seen that process optimisation – like establishing special anaesthesia protocols that allow early mobilisation after joint replacement surgery – can really reduce the length of stay [1] [2]. The positive effects go all the way to ambulatory surgery for a select patient population,” [3] said Mr. Green.

Decreasing LOS and increasing ambulatory surgery are increasingly important when efficient use of hospital beds remains critical for care centres. 

Similarly, ring-fenced beds have been a topic in elective surgery before, with the GIRFT recommendations in 2015 showing the benefits of reduced infections, better outcomes and improved morale [4].

“Hospitals have adapted the care protocols developed for containing infections like MRSA to use to combat COVID-19. Using ring-fenced orthopaedic beds has limited the risk to patients by protecting them from infection,” [5] said Mr. Green.

The Zimmer Biomet team believes in encouraging patients to be “co-producers” of their recovery. Technology has helped maintain this dynamic at a time when people have been discouraged from in-person consultations.

“Active patient engagement helps improve outcomes and efficiency [6]. Industry plays a key role here, for example by providing technologies that help the patient both pre- and post-surgery by educating about a surgical intervention, guiding through recovery protocols and even enabling remote contact of care workers and patients,” said Mr. Green.

Now, more than ever, remote solutions are needed to help maintain safety, and the win-win is that patient engagement is proven to improve Patient-Reported Outcome Measures [7] [8].

When it comes to treating degenerative musculoskeletal diseases, the industry used to traditionally focus on the last stage of treatment, that is a joint replacement. But clinically valid innovations for early intervention have recently become available that may delay the need for total joint replacement. In the COVID-19 climate, having early, less intensive ambulatory interventions to alleviate patients’ pain and improve mobility is beneficial [9].

“A significant number of elective surgeries were postponed across Europe in 2020, with hospitals facing procedure backlogs that are now being addressed as operating rooms (OR) return to their usual capacity. Having patients wait for joint replacements can cause all sorts of issues – so being able to “catch up” in a safe, effective and efficient manner, clinicians need to put focus not just on speed but also on the reproducibility of procedures. Optimised OR protocols including surgery-assisting robots may help,” explains Mr Green.

Dr. Cristina Crisan Tran runs the Zimmer Biomet Institute (ZBI) EMEA, through which the company delivers training and education for health care professionals at all levels.

“Ongoing health care professional training is essential, especially during these times, when surgeons have had reduced operating hours and increasing waiting lists,” says Dr. Crisan Tran. “The ZBI remained committed to fulfil the educational needs of health care professionals by tapping into our comprehensive curriculum and providing personalised educational pathways digitally.

Healthcare is not immune to rapidly changing technology and medical education is no different. While COVID-19 had a significant impact on surgeon training, both at consultant and trainee level, ZBI had an already established internet-based solution which meant it could quickly transform courses into online training.

The ZBI Network EMEA is the company’s interactive online platform where HCPs can access educational tools for product, procedure, instrumentation, and related technologies.

“Training on the safe and effective use of instruments and implants continues to be a priority, and the pandemic has shown that, in many cases, it can be done effectively remotely,” says Dr. Crisan Tran.

“We have taken virtual training even further lately, for example by offering the opportunity for professional exchange, including case discussion on the ZBI Network. A lot of what we have developed during the pandemic is here to stay and we expect to continue to deliver more training online throughout 2021 and into the future,” she added.

While digital is not a replacement of traditional hands-on training, it becomes an integrative part of a learner centric educational approach, allowing surgeons to learn anywhere, at any time.

While the pandemic brought some unprecedented challenges, it has shown that improving quality of life for people around the world can only be achieved when we join forces: team members, hospital partners, patients and authorities can all continue to contribute, share best practices and learn together to better serve patients in the continuing environment and beyond.



[1] Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248(2):189-198.

[2] Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation, BJA. VOLUME 78, ISSUE 5, P606-617, MAY 01, 1997

[3] Outpatient Total Joint Arthroplasty Jack M. Bert,1,2 Jessica Hooper,3 and Sam Moen 1

Curr Rev Musculoskelet Med. 2017 Dec; 10(4): 567–574.

 [4] Green M, Tung E, Al-Dadah O. The value of ring-fenced beds in elective lower limb arthroplasty; Brit J Hosp Med (London, England, 2005) 80(7):405-409, July 2019

[5] The value of ring-fenced beds in lower limb arthroplasty. Mathew Green, Eleanor Tung, Oday Al-Dadah. Br J Hosp Med (Lond). 2019 Jul 2;80(7):405-409. doi: 10.12968/hmed.2019.80.7.405.

[6] A multifaceted intervention to improve the quality of care for patients undergoing total joint arthroplasty. Lyle Sorensen, Lori Idemoto, Janet Streifel, Barbara Williams, Robert Mecklenburg, Craig Blackmore. BMJ Quality Improvement report

[7] Bertakis K, Azari R: Determinants and Outcomes of Patient-Centered Care, Patient Educ Couns 7 August 2010

[8] Bertakis K, Azari R: Patient-Centered Care is Associated with Decreased Health Care Utilization, J Am Board Fam Med May 2011, 24 (3) 229-239

[9] Clinical Investigation Report – 36 Month, APSS-33-00, Version 1.0. 14 January 2019.