Objectives: Despite clinical and economic advantages, routine utilization of telemedicine remains uncommon. The purpose of this study was to examine potential disparities in access and utilization of telehealth services during the rapid transition to virtual clinic during the coronavirus pandemic. Design: Retrospective chart review. Setting: Outpatient visits (in-person, telephone, virtual—Doxy.me) over a 7-week period at a Level I Trauma Center orthopaedic clinic. Intervention: Virtual visits utilizing the Doxy.me platform. Main Outcome Measures: Accessing at least 1 virtual visit (“Virtual”) or having telephone or in-person visits only (“No virtual”). Methods: All outpatient visits (in-person, telephone, virtual) during a 7-week period were tracked. At the end of the 7-week period, the electronic medical record was queried for each of the 641 patients who had a visit during this period for the following variables: gender, ethnicity, race, age, payer source, home zip code. Data were analyzed for both the total number of visits (n = 785) and the total number of unique patients (n = 641). Patients were identified as accessing at least 1 virtual visit (“Virtual”) or having telephone or in-person visits only (“No virtual”). Results: Weekly totals demonstrated a rapid increase from 0 to greater than 50% virtual visits by the third week of quarantine with sustained high rates of virtual visits throughout the study period. Hispanic and Black/African American patients were able to access virtual care at similar rates to White/Caucasian patients. Patients of ages 65 to 74 and 75+ accessed virtual care at lower rates than patients ≤64 ( P = .003). No difference was found in rates of virtual care between payer sources. A statistically significant difference was found between patients from different zip codes ( P = .028). Conclusion: A rapid transition to virtual clinic can be performed at a level 1 trauma center, and high rates of virtual visits can be maintained. However, disparities in access exist and need to be addressed.

Abstract. Prosthetic joint infection (PJI) is a devastating complication after total hip arthroplasty (THA). The common treatment in the USA is a two-stage exchange which can be associated with significant morbidity and mortality. The purpose of this study was to analyze complications in the treatment course of patients undergoing two-stage exchange for PJI THA and determine when they occur. Methods: We analyzed all patients that underwent two-stage exchange arthroplasty for treatment of PJI after THA from January 2005 to January 2018 at a single institution. Complications were categorized as medical or surgical and divided into interstage and post-reimplantation. Minimum follow-up was 1 year. Success was based on the MusculoSkeletal Infection Society (MSIS) definition. Results: 205 hips (203 patients) underwent first stage of planned two-stage exchange. The median age was 68 (interquartile range (IQR) 18). There were 97 males and 106 females. Overall, 73/205 (38 %) patients had at least one complication during treatment: 13.5 % (25/185) of patients experienced a medical complication and 28.1 % (52/185) a surgical complication; 2.4 % died within 1 year of surgery, and 4.9 % (15/203) had mortality at a median of 2.5 years (IQR 4.9); 27 % of patients had complications during the interstage period, most commonly being recurrence of infection requiring additional surgery (63 %); and 14 % of patients experienced a complication following reimplantation, most commonly persistence or recurrence of infection (59 %). While 92 % of patients that initiated treatment were ultimately reimplanted, only 69 % were infection free at 1 year and required no additional treatment. Conclusions: While two-stage exchanges for PJI in THA have been reported as successful, there are few reports of the complications during the process. In our series, significant numbers of patients experienced complications, often during the interstage period, highlighting the morbidity of this method of treatment.