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BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic has led to an increase in telehealth utilization across the health-care sector. It is unknown if telehealth use among hip and knee arthroplasty clinics has remained an important health-care delivery platform. The purpose of the present study was to analyze telehealth utilization before and for 1 year during the pandemic among four varied hip and knee arthroplasty clinics.MethodsRetrospective data were available from four regionally diverse hip and knee arthroplasty centers. Data on volume of patient visits, demographics, visit types (new visit, follow-up, postoperative visit, other), and visit modality (in-person, telehealth, telephone) were available from January 2020 through April 2021. Data from the centers were analyzed as a total and separately, using chi-squared and Fisher exact tests.ResultsAmong the four centers, there were 296,540 hip and knee arthroplasty outpatient clinic visits between January 2020 and April 2021. Of those, 15,240 (5%) were telehealth visits. Before March 2020, less than 0.1% of visits across centers occurred over telehealth. The highest utilization of telehealth visits occurred in March 2020 (>55%) and April 2020 (>25%). From August 2020 until April 2021, telehealth visits accounted for 2%-3% of total visits. Younger patients (

BackgroundThe response to COVID-19 catalyzed the adoption and integration of digital health tools into the health care delivery model for musculoskeletal patients. The change, suspension, or relaxation of Medicare and federal guidelines enabled the rapid implementation of these technologies. The expansion of payment models for virtual care facilitated its rapid adoption. The authors aim to provide several examples of digital health solutions utilized to manage orthopedic patients during the pandemic and discuss what features of these technologies are likely to continue to provide value to patients and clinicians following its resolution.ConclusionThe widespread adoption of new technologies enabling providers to care for patients remotely has the potential to permanently change the expectations of all stakeholders about the way care is provided in orthopedics. The new era of Digital Orthopaedics will see a gradual and nondisruptive integration of technologies that support the patient's journey through the successful management of their musculoskeletal disease.

Background: When comparing functional outcomes of patients with unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA), studies often report the UKA as the preferred procedure; however, recent improvements in the design of modern TKA implants have aimed at narrowing this gap. Purpose: We sought to compare the "feel" of modern TKA implants to that of UKA, using the Forgotten Joint Score (FJS), a validated patient-reported outcome measure. Methods: We performed a retrospective review of patients who underwent TKA and UKA at 2 institutions between 2014 and 2017. All UKA procedures were robotic arm-assisted with a single implant, "traditional TKAs" were performed using traditional posterior-stabilized implants, and "modern TKAs" were performed using posterior-stabilized implants with a modern design. Differences in FJS were assessed using 1-way analysis of variance and independent 2-sample t tests. Results: A total of 600 patients were included in our study, with 200 patients in each surgical subcategory. Mean age was 62.8 ± 10.2 years and mean body mass index was 29.9 ± 4.9. Modern TKA and UKA had similar FJS at 1 year. While modern TKA had a significantly higher FJS than traditional TKA, UKA did not have a significantly higher FJS than traditional TKA. Conclusion: Our retrospective analysis found no significant differences in the FJS of patients who underwent UKA and TKA with a modern design; however, both had superior scores than traditional TKA designs. This finding suggests that modern TKA designs may have the potential to achieve the natural feeling that is typically associated with joint-conserving surgeries such as UKA, although longer follow-up is necessary. [ABSTRACT FROM AUTHOR]

Background: The interest in ambulatory total hip arthroplasty (THA) has increased recently due to a national focus on value-based care and improved rapid recovery protocols. Purpose: We sought to determine if surgical approach had an effect on discharge outcomes in outpatient THA. Methods: We performed a retrospective cohort study examining patients who underwent unilateral THA at a single institution using a standardized perioperative care pathway who were discharged home within 24 hours. In total, we compared 106 patients who underwent THA using the direct anterior approach (ATHA) and 90 patients who underwent THA using the posterior approach (PTHA). Univariate and multivariable analyses were used to compare time to ambulation, length of surgery, readmissions, and 90-day complications. Results:Time to ambulation in the ATHA and PTHA groups was 3.9 hours and 4.1 hours, respectively, and time to discharge was 5.9 hours and 6.0 hours, respectively. Length of surgery was shorter in the ATHA group than in the PTHA group (78 minutes vs 86 minutes, respectively). Complications occurred in 3 patients (3%) in the ATHA group vs 4 patients (4%) in PTHA group. In both groups, early ambulation (within 5 hours) predicted earlier time to discharge. Surgical approach was not associated with time to ambulation or time to discharge on multivariable analysis. Conclusion: In this retrospective study, outpatient THA was feasible in a well-selected population of patients undergoing anterior or posterior approaches. Further study is warranted. [ABSTRACT FROM AUTHOR]

Background: Implant selection in the operating room is a manual process. This manual process combined with complex compatibility rules and inconsistent implant labeling may lead to implant-selection errors. These might be reduced using an automated process; however, little is known about the efficacy of available automated error-reduction systems in the operating room.Questions/purposes: (1) How often do implant-selection errors occur at a high-volume institution? (2) What types of implant-selection errors are most common?Methods: We retrospectively evaluated our implant log database of 22,847 primary THAs and TKAs to identify selection errors. There were 10,689 THAs and 12,167 TKAs included during the study period from 2012 to 2017; there were no exclusions and we had no missing data in this study. The system provided an output of errors identified, and these errors were then manually confirmed by reviewing implant logs for each case found in the medical records. Only those errors that were identified by the system were manually confirmed. During this time period all errors for all procedures were captured and presented as a proportion. Errors identified by the software were manually confirmed. We then categorized each mismatch to further delineate the nature of these events.Results: One hundred sixty-nine errors were identified by the software system just before implantation, representing 0.74 of the 22,847 procedures performed. In 15 procedures, the wrong side was selected. Twenty-five procedures had a femoral head selected that did not match the acetabular liner. In one procedure, the femoral head taper differed from the femoral stem taper. There were 46 procedures in which there was a size mismatch between the acetabular shell and the liner. The most common error in TKA that occurred in 46 procedures was a mismatch between the tibia polyethylene insert and the tibial tray. There were 13 procedures in which the tibial insert was not matched to the femoral component according to the manufacturer's guidelines. Selection errors were identified before implantation in all procedures.Conclusions: Despite an automated verification process, 0.74% of the arthroplasties performed had an implant-selection error that was identified by the software verification. The prevalence of incorrect/mismatched hip and knee prostheses is unknown but almost certainly underreported. Future studies should investigate the prevalence of these errors in a multicenter evaluation with varying volumes across the involved sites. Based on our results, institutions and management should consider an automated verification process rather than a manual process to help decrease implant-selection errors in the operating room.Level Of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

Background: The early months of the coronavirus disease 19 (COVID-19) pandemic in New York City led to a rapid transition of non-essential in-person health care, including outpatient arthroplasty visits, to a telemedicine context. Questions/Purposes: Based on our initial experiences with telemedicine in an outpatient arthroplasty setting, we sought to determine early lessons learned that may be applicable to other providers adopting or expanding telemedicine services. Methods: A cross-sectional study was performed by surveying all patients undergoing telemedicine visits with 8 arthroplasty surgeons at 1 orthopedic specialty hospital in New York City from April 8 to May 19, 2020. Descriptive statistics were used to analyze demographic data, satisfaction with the telemedicine visit, and positive and negative takeaways. Results: In all, 164 patients completed the survey. The most common reasons for the telemedicine visit were short-term (less than 6 months), postoperative appointment ( n = 88; 54%), and new patient consultation ( n = 32; 20%). A total of 84 patients (51%) noted a reduction in expenses versus standard outpatient care. Several positive themes emerged from patient feedback, including less anxiety and stress related to traveling ( n = 82; 50%), feeling more at ease in a familiar environment ( n = 54; 33%), and the ability to assess postoperative home environment ( n = 13; 8%). However, patients also expressed concerns about the difficulty addressing symptoms in the absence of an in-person examination ( n = 28; 17%), a decreased sense of interpersonal connection with the physician ( n = 20; 12%), and technical difficulties ( n = 14; 9%). Conclusions: Patients were satisfied with their telemedicine experience during the COVID-19 pandemic; however, we identified several areas amenable to improvement. Further study is warranted., Competing Interests: Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Drake G. LeBrun, MD, MPH, Christina Malfer, BA, Mallory Wilson, BA, Kaitlin M. Carroll, BA, and Victoria Wang declare that they have no conflicts of interest. David J. Mayman, MD, reports stock or stock options from Imagen, Wishbone, and Insight; stock or stock options and royalties from Orthalign; and personal fees, royalties, and research support from Smith and Nephew, outside the submitted work. Michael B. Cross, MD, reports personal fees from Depuy, Smith and Nephew, and Flexion Therapeutics; personal fees and research support from Exactech; personal fees and stock or stock options from Imagen; personal fees, research support, and stock or stock options from Intellijoint; personal fees and research support from KCI; and stock or stock options from Parvizi Surgical Innovation, outside the submitted work. Michael M. Alexiades, MD, reports personal fees and royalties from DJ Orthopedics, outside the submitted work. Seth A. Jerabek, MD, reports stock or stock options from Imagen, personal fees and research support from Stryker, outside the submitted work. Fred D. Cushner, MD, reports personal fees from Acelity and Smith and Nephew, stock or stock options from Canary Medical, personal fees and stock or stock options from Orthalign, outside the submitted work. Jonathan M. Vigdorchik, MD, reports personal fees and research support from Corin, personal fees and stock or stock options from Intellijoint, and personal fees from Medacta, Motion Insights, and Zimmer, outside the submitted work. Steven B. Haas, MD, reports personal fees from Smith and Nephew, outside the submitted work. Michael P. Ast, MD, reports personal fees from Conformis, Stryker, and Surgical Care Affiliates; personal fees, stock or stock options, and royalties from Orthalign; stock or stock options from OSSO VR; and personal fees and research support from Smith and Nephew, outside the submitted work., (© The Author(s) 2020.)

Introduction: Simultaneous bilateral total knee arthroplasty (bTKA) is a viable option for treatment of bilateral knee osteoarthritis. The aim of this study is to identify the impact of biological sex on postoperative outcomes., Methods: A retrospective cohort study was conducted utilizing the ACS-NSQIP database. bTKA patients were identified and stratified into groups based upon biological sex. Adverse events after surgery was evaluated with univariate and multivariate analysis., Results: Biological sex is not an independent risk factor for development of postoperative complications., Conclusion: When determining patient qualification of simultaneous or staged bTKA, biological sex should not be taken into consideration., (© 2019 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)