Developing a standardized approach to virtual clinic follow-up of hip and knee arthroplasty

Preston, Nick; McHugh, Gretl A.; Hensor, E.M.; Grainger, Andrew J.; O’Connor, Philip; Conaghan, Philip G.; Stone, Martin; Kingsbury, Sarah R.

doi:10.1302/0301-620x.101b8.bjj-2018-1566.r1

Cited by 10 publications

(9 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a study performed by El Ashmawy et al., it was found that less than 10% of patients needed an in-person appointment after their total joint arthroplasty [ 8 ]. In recent years, a standardized approach has been developed by numerous specialists involved in total joint arthroplasty patient care, which allows for the safe implementation of virtual arthroplasty clinics across the United Kingdom [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Knee Flexion Angle Measurement Using Virtual Assessment Tools: Correct Procedure and Potential Pitfalls

Sheridan¹,

Keenan²,

Beverland³

2022

Arthroplasty Today

View full text Add to dashboard Cite

Virtual patient assessment will inevitably require smartphone technology to remotely measure knee range of motion. We conducted an experiment to analyze the impact of observer position relative to the flexed knee on the perceived angle measured using an electronic application (Dr. Goniometer) for iPhone. Two observers measured the apparent knee flexion angle from 7 different positions at 3 different heights relative to the center of the knee joint. Intraclass correlations were calculated to evaluate the intraobserver and interobserver variability using two-way mixed-effects models. The intraclass correlation for interobserver variability was excellent at 0.804 (95% confidence interval 0.663-0.889). When the observer was greater than 15 from the knee perpendicular, the true angle of knee flexion (90 ) was not observed in any of the measurements. This was the case when observed from both proximal (range 95 -121 ) and distal (range 92 -108 ) directions. Ideally the camera lens should be perpendicular to the long axis of the lower limb in the proximal-distal direction and at the same height. However, if the camera lens is within 15 of the perpendicular, then at 90 of true flexion, the perceived angle will not be greater than 95 in 94% of cases.

show abstract

Section: Discussionmentioning

confidence: 99%

Knee Flexion Angle Measurement Using Virtual Assessment Tools: Correct Procedure and Potential Pitfalls

Sheridan¹,

Keenan²,

Beverland³

2022

Arthroplasty Today

View full text Add to dashboard Cite

show abstract

“…Virtual clinic models have previously been developed and evaluated for hip and knee replacement follow-up, and are already established in some centres. 52,171 Each major regional centre should identify a radiography facility with the appropriate expertise to offer this service. This may be run by the radiology department, the orthopaedic department or a combined multidisciplinary team.…”

Section: Evidence-based Follow-up Recommendationsmentioning

confidence: 99%

“…Evidence-based standardised radiology reporting (e.g. reporting methods previously developed by members of the UK SAFE team 171 ) should be considered.…”

Section: Evidence-based Follow-up Recommendationsmentioning

confidence: 99%

Safety of disinvestment in mid- to late-term follow-up post primary hip and knee replacement: the UK SAFE evidence synthesis and recommendations

Kingsbury

Smith

Czoski-Murray

et al. 2022

Health Soc Care Deliv Res

View full text Add to dashboard Cite

Background Joint replacement surgery has revolutionised the management of degenerative joint disease. Increasing demand for surgery and post-surgical reviews has overwhelmed orthopaedic services and, consequently, many centres have reduced or stopped follow-up. Such disinvestment is without an evidence base and raises questions regarding the consequences to patients. Objectives To produce evidence- and consensus-based recommendations as to how, when and on whom follow-up should be conducted. Our research question was ‘Is it safe to disinvest in mid- to late-term follow-up of hip and knee replacement?’. Methods The study comprised three complementary evidence synthesis work packages to inform a final consensus process. Work package 1 was a systematic review of the clinical effectiveness and cost-effectiveness literature. Work package 2 used routine national data sets (i.e. the Clinical Practice Research Datalink–Hospital Episode Statistics, Hospital Episode Statistics–National Joint Registry–patient-reported outcome measures) to identify pre, peri and postoperative predictors of mid- to late-term revision, and prospective data from 560 patients to understand how patients present for revision surgery. Work package 3 used a Markov model to simulate the survival, health-related quality of life and NHS costs of patients following hip or knee replacement surgery. Finally, evidence from work packages 1–3 informed a face-to-face consensus panel, which involved 32 stakeholders. Results Our overarching statements are as follows: (1) these recommendations apply to post primary hip and knee replacement follow-up; (2) the 10-year time point in these recommendations is based on a lack of robust evidence beyond 10 years; and (3) in these recommendations, the term ‘complex cases’ refers to individual patient and surgical factors that may increase the risk of replacement failure. Our recommendations are as follows: for Orthopaedic Data Evaluation Panel 10A* (ODEP-10A*) minimum implants, it is safe to disinvest in routine follow-up from 1 to 10 years post non-complex hip and knee replacement provided that there is rapid access to orthopaedic review; (2) for ODEP-10A* minimum implants in complex cases or non-ODEP-10A* minimum implants, periodic follow-up post hip and knee replacement may be required from 1 to 10 years; (3) at 10 years post hip and knee replacement, clinical and radiographic evaluation is recommended; and (4) after 10 years post hip and knee replacement, frequency of further follow-up should be based on the 10-year assessment (note that ongoing rapid access to orthopaedic review is still required) [Stone M, Smith L, Kingsbury S, Czoski-Murray C, Judge A, Pinedo-Villanueva R, et al. Evidence-based follow-up recommendations following primary hip and knee arthroplasty (UK SAFE). Orthop Proc 2020;102–B:13. https://doi.org/10.1302/1358-992X.2020.5.013]. Limitations The current absence of data beyond 10 years restricted the evidence base. Conclusions For ODEP-10A* prostheses, the UK SAFE programme demonstrated that it is safe to disinvest in routine follow-up in the 1- to 10-year period after non-complex hip and knee replacement. At 10 years, clinical and radiographic review is recommended. Complex cases, implants not meeting the 10A* criteria and follow-up after revision surgery are not covered by this recommendation. Future work The evidence base for follow-up after 10 years requires further evaluation. Further work should establish the most clinically effective and cost-effective model of delivering a rapid access service and evaluate alternative models for follow-up services, such as virtual clinics. Finally, the needs and outcomes of patients who are symptomatic but do not have appropriate follow-up should be investigated. Study registration This study is registered as PROSPERO CRD42017053017. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 16. See the NIHR Journals Library website for further project information.

show abstract

“…In 2014, Sharareh and Schwarzkopf compared on-site postoperative follow-up visits with remote consultations and concluded that patients who underwent telemedicine follow-up rated their postoperative satisfaction higher [42]. More recently in 2019, Preston et al [37] provided a standardized approach and assessment of virtual follow-up of hip and knee arthroplasty patients. Their approach and methods of documentation were well accepted by orthopedic experts, radiologists, and patients.…”

Section: Performance Of Telemedicine Examinationmentioning

confidence: 99%

An Overview of Telehealth in Total Joint Arthroplasty

Windsor

Sharma

Gkiatas

et al. 2021

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

View full text Add to dashboard Cite

With the increase in technological advances over the years, telehealth services in orthopedic surgery have gained in popularity, yet adoption among surgeons has been slow. With the onset of the COVID-19 pandemic, however, orthopedic surgery practices nationwide have accelerated adaptation to telemedicine. Telehealth can be effectively applied to total joint arthroplasty, with the ability to perform preoperative consultations, postoperative follow-up, and telerehabilitation in a virtual, remote manner with similar outcomes to in-person visits. New technologies that have emerged, such as virtual goniometers, wearable sensors, and app-based patient questionnaires, have improved clinicians’ ability to conduct telehealth visits. Benefits of using telehealth include high patient satisfaction, cost-savings, increased access to care, and more efficiency. Notably, some challenges still exist, including widespread accessibility and adaptation of new technologies, inability to conduct an in-person orthopedic physical examination, and regulatory barriers, such as insurance reimbursement, increased medicolegal risk, and privacy and confidentiality concerns. Despite these hurdles, telehealth is here to stay and can be successfully incorporated in any total joint arthroplasty practice with the appropriate adjustments.

show abstract

Developing a standardized approach to virtual clinic follow-up of hip and knee arthroplasty

Cited by 10 publications

References 16 publications

Knee Flexion Angle Measurement Using Virtual Assessment Tools: Correct Procedure and Potential Pitfalls

Knee Flexion Angle Measurement Using Virtual Assessment Tools: Correct Procedure and Potential Pitfalls

Safety of disinvestment in mid- to late-term follow-up post primary hip and knee replacement: the UK SAFE evidence synthesis and recommendations

An Overview of Telehealth in Total Joint Arthroplasty

Contact Info

Product

Resources

About