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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: Nosocomephobia, a type of posttraumatic stress disorder (PTSD), is a diagnosis of an extreme fear of hospitals that can hinder current/future medical care. There is little research on how nosocomephobia affects elective surgery or how acupuncture can help patients cope. Methods: Using the transactional model of stress/coping, this qualitative case study examined the role of acupuncture in nosocomephobia patients' elective surgery appraisal processes. Two patients were interviewed about their nosocomephobia and prior hospital experiences. Six reviewers coded interview transcripts line-by-line using Dedoose software. Reviewers labeled meaningful words, phrases and sentences and produced over 600 codes. Reviewers discussed/identified themes by grouping similar codes and resolving discrepancies. A thematic analysis was then used to develop final themes. Pseudonyms were assigned to protect patient privacy. Sophie had avascular necrosis in both hips and suffered PTSD from a previous traumatic event. Intraoperative acupuncture calmed her hospital anxiety, allowing her to have both hips replaced. Olivia had experienced PTSD and hospital phobia since she was 12 years old. Acupuncture reduced her anxiety surrounding a necessary knee arthrotomy and osteochondral allograft. Results: Thematic analysis showed how nosocomephobia impacted patients' views of surgery and distinguished between their unique fear rationale. The transactional model of stress/coping illustrated patients' appraisal process from surgery (stressor) to coping (acupuncture) to reappraisal (mental state). Conclusion: Procedural visits can be stressful due to already heightened anxiety. Although no definitive conclusions can be drawn from this small, uncontrolled case series, acupuncture may represent a safe, noninvasive way for nosocomephobia patients to manage preoperative anxiety. [ABSTRACT FROM AUTHOR]

Introduction: Modern primary cementless total knee arthroplasty (TKA) is increasingly popular, but there is limited evidence on its benefits, early complications, and failures. Purpose: We sought to evaluate operative time, early survivorship, and outcomes of cementless versus cemented TKA of the same design. Methods: As part of this single-center, multisurgeon, retrospective cohort study, we reviewed 598 primary, unilateral TKAs (170 cementless, 428 cemented) of the same design from 2016 to 2018. The cementless cohort was younger (63 vs 67 years) and had more cruciate-retaining implants (17% vs 12%) compared with the cemented cohort. We compared operative time, length of stay, and complications. Survivorship curves were generated via the Kaplan-Meier method. Results: Patients with cementless TKA (using the Triathlon implant, Stryker) had a 24% reduction in operative time (83 vs 109 minutes) but similar length of stay compared with those with cemented TKA (57 vs 61 hours). Cementless TKA had a higher rate of postoperative manipulation for stiffness compared with cemented TKA (8% vs 3%), but there were notable demographic differences between the cohorts. Despite 2 cases (1%) of early cementless tibial aseptic loosening requiring component revision compared with none in the cemented cohort, there was no difference in revision-free survivorship at 2 years (96% and 98%, respectively). Conclusion: This retrospective cohort study found that cementless TKA had a 24% reduction in operative time compared with cemented TKA and similar short-term survivorship. There was a slightly higher rate of aseptic revision and manipulation in the cementless cohort. Further study is warranted on the long-term durability of cemented and cementless TKAs to determine if cementless fixation proves more durable in the midterm to long term. [ABSTRACT FROM AUTHOR]