Introduction. Employer-sponsored travel surgery programs for commonly performed procedures like total joint arthroplasty (TJA) are increasing, as employers try to more effectively manage the healthcare costs of their employees. This new approach by employers to direct their employees to designated “Centers of Excellence” (COEs) creates a need to characterize the “travel patient” population that commutes long distances to receive their surgical care and returns home for their rehab shortly after surgery. Electronic patient rehabilitation platforms (EPRA) facilitate communication, patient navigation, and care coordination across this complex episode of care and may contribute to improved outcomes after TJA. The aim of this study is to evaluate patient satisfaction, functional outcomes and engagement with the use of an EPRA among two TJA cohorts: 1) travel and 2) non-travel TJA patients. Methods. A retrospective review was performed on total knee (TKA) and total hip (THA) arthroplasty patients at a single institution during the first 6 months following implementation of an EPRA. All patients were offered internet based access to an EPRA which provided instant messaging with the care team, algorithmic navigation of the patient during the pre and post-op phases, and access to an extensive library of educational videos regarding their surgery, rehab, and FAQs. Primary outcome measures were the pre-op and 12 week post op HOOS Jr. and KOOS Jr. Patient satisfaction at 12 weeks after surgery and engagement metrics for the EPRA were also examined. Cases were separated into two groups: travel and non-travel, and the groups were compared in terms of engagement, improvement in functional outcomes, and patient satisfaction. Chi-square test and t-test statistics were used for analysis. Results. 634 TJA cases (100 travel; 534 non-travel) were included in this study. Age and BMI differed significantly between these cohorts (p<0.001). The mean age and BMI were 59.17 and 33.01, respectively for travel patients and 69.27 and 29.56, respectively for non-travel patients. 97% of the travel patients initially opted-in to use the electronic rehabilitation program compared to 87.6% of the non-travel patients. The number of travel patients logging in, watching videos, and messaging was significantly higher than that of non-travel patients (p<0.01). On average, travel patients generated double the number of sessions than non-travel patients (71.5 vs 31.5, p<0.001). Among TKA cases, travel patients reported significantly lower pre-op mean KOOS Jr. scores than non-travel patients (43.11 vs. 47.78, p< 0.01). By 12 weeks, there was no difference between the groups (67.11 vs. 70.05, p=0.15). THA cases exhibited similar increases in patient reported outcomes(PROs). Mean pre-op HOOS Jr scores for travel and non-travel patients were 42.64 and 48.16 respectively (p=0.07) and mean post-op HOOS Jr. scores at 12 weeks were 75.93 and 80.12, respectively (p=0.15). Comparing 12 week procedure satisfaction (0–5), travel THA patients reported significantly higher mean satisfaction than non-travel THA cases (4.93 vs 4.32, p<0.001). There was no difference in satisfaction between travel TKA and non-travel TKA cases (4.31 vs 4.35, p=0.85). Conclusion. This study revealed higher engagement among travel patients in comparison to non-travel patients as measured by utilization of EPRA. Patients participating in these programs are typically incentivized financially in terms of enhanced insurance coverage and elimination of out-of-pocket expenses when they obtain care at an employer designated COE which may contribute to this increased degree of engagement. Increased utilization of EPRA may have also contributed to higher 12 week patient satisfaction. Despite the logistical challenges of travel TJA surgery, the EPRA used in this study appears to facilitate effective patient navigation and care coordination in the travel patient population, resulting in patient reported outcomes and satisfaction that is comparable to our non-travel patient population. Considering the projected increased growth of these employer directed COE programs, further understanding of these travel surgery patients and the role of electronic patient engagement platforms and telehealth technologies is warranted. For figures, tables, or references, please contact authors directly

Introduction. In recent years, online patient portals have been developed to offer the potential of an enhanced recovery experience. By offering videos, communication tools and patient-reported outcomes collection, online portals encourage patient's engagement in their care. In the total joint arthroplasty population, portals may also offer online physical therapy, allowing TJA patients to reach functional goals while reducing costs. Although technology may offer the potential of an enhanced recovery experience, disparities may exist between the comfort level of use and communication preferences of different patient populations. Our study aimed to analyze the utilization of an internet based patient portal, and quantify the impact of usage on patient reported outcome measures. Methods. 4,458 patients who underwent TJA across 8 major academic centers within one healthcare system were analyzed. Patients who scheduled surgery were registered for the online portal by the surgical coordinator. Upon registration, patients opt-in by signing a license agreement, and data is collected on their utilization of the portal including logins, exercise and educational videos watched, messages sent and PROs completed. Age was compared to utilization, opt-in rates, total videos watched, and messages sent. Two separate patient cohorts were identified to distinguish between active and non-active users. Anyone who opted-in and viewed over 5 preoperative videos or had at least 5 preoperative logins were considered active users. Patients’ postoperative KOOS-JR and HOOS-JR score improvements from baseline were compared between the active vs. non-active groups. Results. Of 4,458 total TJA patients, TKA and THA comprised 2670 and 1788, respectively, with an average age of 65.9 years (range 16–96 years). On average, patients logged into the portal 3.7 times preoperatively and 6.8 times postoperatively, and sent 2.29 messages. On average, 13 videos were watched preoperatively and 17 videos were watched postoperatively. Of all TJA patients, 72% opted-in to the portal. When looking solely at the TKA cohort, there was a significant difference in age between those patients that provided an email and those who didn't. The mean age of those who did provide an email was 66.3 years old, patients who didn't were on average 69.7 years old (p =.001). There was no significant impact of age on total preoperative or postoperative logins when considering both TKA and THA patients. There was a significant difference between age and preoperative or postoperative logins in the TKA group, with older patients tending to log in less (p =.001) and send fewer messages to the care team (p =.0001). Total videos watched preoperatively and postoperatively as well as preoperative logins did not impact change of HOOS JR scores at 6 weeks, 12 weeks, 6 months or 1 year. In the TKA cohort, the active user cohort correlated to greater improvement in KOOS-JR scores at 6 weeks, and 12 weeks postoperatively (p=.02, .018 respectively). Conclusion. While older TKA patients tended to be less engaged, the usage of the online portal overall was not impacted by age in the TJA population. As the average age of patients undergoing TKA continues to decrease, surgeons will be faced with a younger patient population that communicates heavily through technology. Previously published literature has proven online PT is as effective as traditional PT, making online portals a promising option to improve care while decreasing costs. As seen in our TKA population, patients experienced greater improvement in KOOS-Jr scores with greater activity and use of the portal

Aims

The COVID-19 pandemic led to a swift adoption of telehealth in orthopaedic surgery. This study aimed to analyze the satisfaction of patients and surgeons with the rapid expansion of telehealth at this time within the division of adult reconstructive surgery at a major urban academic tertiary hospital.

Aims

Meeting preoperative expectations is known to be of major influence on postoperative satisfaction after total knee arthroplasty (TKA). Improved management of expectation, resulting in more realistic expectations can potentially lead to higher postoperative satisfaction. The objective of this study was to assess the effect of an additional preoperative education module, addressing realistic expectations for long-term functional recovery, on postoperative satisfaction and expectation fulfilment.

Aims

Since redesign of the Oxford phase III mobile-bearing unicompartmental knee arthroplasty (UKA) femoral component to a twin-peg design, there has not been a direct comparison to total knee arthroplasty (TKA). Thus, we explored differences between the two cohorts.

Anterior cruciate ligament (ACL) reconstruction is commonly performed and has been for many years. Despite this, the technical details related to ACL anatomy, such as tunnel placement, are still a topic for debate. In this paper, we introduce the flat ribbon concept of the anatomy of the ACL, and its relevance to clinical practice.

Cite this article: Bone Joint J 2016;98-B:1020–6.

Previous studies of failure mechanisms leading to revision total knee replacement (TKR) performed between 1986 and 2000 determined that many failed early, with a disproportionate amount accounted for by infection and implant-associated factors including wear, loosening and instability. Since then, efforts have been made to improve implant performance and instruct surgeons in best practice. Recently our centre participated in a multi-centre evaluation of 844 revision TKRs from 2010 to 2011. The purpose was to report a detailed analysis of failure mechanisms over time and to see if failure modes have changed over the past 10 to 15 years. Aseptic loosening was the predominant mechanism of failure (31.2%), followed by instability (18.7%), infection (16.2%), polyethylene wear (10.0%), arthrofibrosis (6.9%) and malalignment (6.6%). The mean time to failure was 5.9 years (ten days to 31 years), 35.3% of all revisions occurred at less than two years, and 60.2% in the first five years. With improvements in implant and polyethylene manufacture, polyethylene wear is no longer a leading cause of failure. Early mechanisms of failure are primarily technical errors. In addition to improving implant longevity, industry and surgeons must work together to decrease these technical errors. All reports on failure of TKR contain patients with unexplained pain who not infrequently have unmet expectations. Surgeons must work to achieve realistic patient expectations pre-operatively, and therefore, improve patient satisfaction post-operatively.

Cite this article: Bone Joint J 2014;96-B(11 Suppl A):101–4.

Patient-reported outcome measures (PROMs) are increasingly being used to assess functional outcome and patient satisfaction. They provide a framework for comparisons between surgical units, and individual surgeons for benchmarking and financial remuneration. Better performance may bring the reward of more customers as patients and commissioners seek out high performers for their elective procedures. Using National Joint Registry (NJR) data linked to PROMs we identified 22 691 primary total knee replacements (TKRs) undertaken for osteoarthritis in England and Wales between August 2008 and February 2011, and identified the surgical factors that influenced the improvements in the Oxford knee score (OKS) and EuroQol-5D (EQ-5D) assessment using multiple regression analysis. After correction for patient factors the only surgical factors that influenced PROMs were implant brand and hospital type (both p < 0.001). However, the effects of surgical factors upon the PROMs were modest compared with patient factors. For both the OKS and the EQ-5D the most important factors influencing the improvement in PROMs were the corresponding pre-operative score and the patient’s general health status. Despite having only a small effect on PROMs, this study has shown that both implant brand and hospital type do influence reported subjective functional scores following TKR. In the current climate of financial austerity, proposed performance-based remuneration and wider patient choice, it would seem unwise to ignore these effects and the influence of a range of additional patient factors.