Orthopedic Surgery and Telemedicine in Times of COVID-19 and Beyond: a Review

Abstract

Purpose of Review This review article presents the current knowledge on the use of telemedicine and summarizes the literature highlighting the advantages and limitations of this technology in the field of orthopedic surgery during the COVID-19 pandemic and beyond. Recent Findings Orthopedic surgery is the surgical specialty that has seen the highest proportion of its procedures cancelled due to the pandemic. In this context and onward, telemedicine seems to be a reasonable option for the orthopedic surgeon. Multiple studies have described its safety and a similar patient satisfaction compared to in-person consultations. It has a potential to increase productivity and decrease wait times by providing easier access to the clinician and by decreasing travel-associated limitations and costs. Authors have described the possibility to conduct a reliable virtual assessment of the patient range of motion. Some of the limitations to the use of this technology are technological literacy and access to virtual consultation platforms, the inability to conduct a complete physical examination, potential reduction in identification of intimate and child abuse victims, and limited knowledge about the legal implications of this technology. Summary Telemedicine in orthopedic surgery has a potential to increase productivity, reduce costs, and increase the access to healthcare. Identified limitations include risk of misdiagnosis, required technologic literacy, unknown legal implications, and failure to identify victims of abuse. In order to use this technology judiciously, the clinician must take into consideration the patient's condition and his technological literacy and be aware of the advantages and disadvantages.

85-Year-Old Postsurgical Complex Patient Successfully Managed Remotely at the Novel Mayo Clinic’s Hospital at Home

“…The traditional practice of medicine involves in-person consultation and examination. However, the current COVID-19 pandemic has obligated that many surgery services adapt quickly and implement telemedicine in their services by the degree of complexity of the patient and telehealth resources available at the different surgery service hospitals [8][9][10]. Telehealth has granted providers the ability to evaluate, diagnose, treat, and provide follow-up to surgical patients, particularly in places where resources and subspecialists are insufficient.…”

“…Telemedicine in the surgical field exhibited the potential to increase productivity, follow-up rates, and access to healthcare by lessening travel-associated limitations [8,17] and reducing costs [8,[18][19][20]. However, some of the limitations reported include the risk of misdiagnoses, information protection, technological literacy, and failure to identify abuse victims [8]. Additionally, the lack of in-person physical examination creates the need for a reliable virtual examination, especially in acute and complex conditions [8].…”

Traumatic orthopedic consultations in COVID-19 inpatients – A cross sectional analysis of results and a review of lessons in tele-orthopedics

“…Further, assessment of patients in the postoperative period may prove convenient; especially when assessing wounds and range of motion. Multiple resources have cited lower costs using the web-based consultations, avoiding the need to travel and consult in person [ 3 , 5 , 6 ].…”

Management of resources for orthopedic oncology and trauma patients during the COVID-19 pandemic: A retrospective cohort study

“…The use of telemedicine systems, which was known and used by orthopedic doctors and patients before the pandemic, increased during the pandemic period [24]. It has been noted in studies that there is no difference in patients' satisfaction between telemedicine and face-toface examination [25,26]. We still believe that face-to-face examinations are more successful and reduce complication rates more efficiently than telemedicine, and so we do not have any current plans to use telemedicine in future.…”