Background The impact of the COVID-19 pandemic In Spain, especially in Madrid, suddenly affected all the activity of the hospital including the suspension of all non-urgent surgical procedures. What´s more crucial, the urgent procedures were seriously obstructed by to factors: the mandatory protection measures (individual protection clothes, facemasks, and their initial stockout, etc), the redesigned flow of the patients in and out the operation room specially because the advisable diagnosis study of severe acute respiratory syndrome related Coronavirus 2 in each patient.Methods We review the patients treated in our orthopedic department during the outbreak of Coronavirus disease 19. Based in our early experience and the emergency situation with high contagious rate in Madrid, Spain, we have built a list of considerations and recommendations to guide orthopaedic units in their resumption of their regular activity, focusing at the moment of reintroduce elective surgeries, during the contained epidemic phases.Results The mortality rate in Coronavirus disease 19 patients was 3/9 and in the non Coronavirus disease group 4/23 developed pneumonia by Coronavirus2 (1 dead). There are no guidelines in literature for orthopedic surgeons in the postpandemic phase.Conclusion Coronavirus disease 19 patients have an elevated morbidity and mortality, surgery during this pandemia can facilitate pneumonia by Coronavirus2. The return-to-practice measures in the orthopedic units must take into account this fact. We recommend for each orthopedic surgery department to create a flowchart, as ours, in order to restart surgical activity.