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. Methods. A total of 334 patients underging arthroplasty of the hip or knee who completed a telemedicine visit between 30 March and 30 April 2020 were sent a 14-question survey, scored on a five-point Likert scale. Eight adult reconstructive surgeons who used telemedicine during this time were sent a separate 14-question survey at the end of the study period. Factors influencing patient satisfaction were determined using univariate and multivariate ordinal logistic regression modelling. Results. A total of 68 patients (20.4%) and 100% of the surgeons completed the surveys. Patients were “Satisfied” with their telemedicine visits (4.10/5.00 (SD 0.98)) and 19 (27.9%) would prefer telemedicine to in-person visits in the absence of COVID-19. Multivariate ordinal logistic regression modelling revealed that patients were more likely to be satisfied if their surgeon effectively responded to their questions or concerns (odds ratio (OR) 3.977; 95% confidence interval (CI) 1.260 to 13.190; p = 0.019) and if their visit had a high audiovisual quality (OR 2.46; 95% CI 1.052 to 6.219; p = 0.042). Surgeons were “Satisfied” with their telemedicine experience (3.63/5.00 (SD 0.92)) and were “Fairly Confident” (4.00/5.00 (SD 0.53)) in their diagnostic accuracy despite finding the physical examinations to be only “Slightly Effective” (1.88/5.00 (SD 0.99)). Most adult reconstructive surgeons, seven of eight (87.5%) would continue to use telemedicine in the future. Conclusion. Telemedicine emerged as a valuable tool during the COVID-19 pandemic. Patients undergoing arthroplasty and their surgeons were satisfied with telemedicine and see a role for its use after the pandemic. The audiovisual quality and the responsiveness of physicians to the concerns of patients determine their satisfaction. Future investigations should focus on improving the physical examination of patients through telemedicine and strategies for its widespread implementation. Cite this article: Bone Joint J 2021;103-B(6 Supple A):196–204

Introduction. The COVID-19 pandemic led to a swift adoption of telehealth in orthopedic surgery. The purpose of this study was to analyze patient and surgeon satisfaction with a rapid expansion of telehealth use during COVID-19 pandemic within the division of adult reconstructive surgery at a major urban academic hospital. Methods. 334 hip and knee arthroplasty patients who completed a telemedicine visit from March 30th, 2020 through April 30th, 2020 were sent a 14-question survey. Eight adult reconstructive surgeons who used telemedicine were sent a separate 14-question survey at the end of the study period. Factors influencing patient satisfaction were determined using univariate and multivariate ordinal logistic regression modeling. Results. 20.4% of patients (68/334) and 100% of surgeons (8/8) completed the surveys. Patients were on average “Satisfied” with their telemedicine visits (4.10/5.00 ± 0.98), 54.4% considered themselves high-risk for COVID-19 complications, and 27.9% reported that they preferred future visits to be conducted using telemedicine for reasons unrelated to COVID-19. Multivariate ordinal logistic regression modeling revealed that patients reported higher satisfaction if their surgeon effectively responded to their questions/concerns (OR 3.977; 95% CI 1.260 to 13.190, p=0.019) and if their visit had higher audiovisual quality (OR 2.46; 95% CI 1.052 to 6.219, p=0.042). Surgeons were “Satisfied” with their telemedicine experience (3.63/5.00 ± 0.92), felt that physical exams conducted via telemedicine were “Slightly Effective” (1.88/5.00 ± 0.99), and believed that 43.5% of visits required an in-person component. Most adult reconstructive surgeons would continue to use telemedicine in the future (87.5%). Conclusion. Telehealth emerged as a valuable tool during the COVID-19 pandemic. Arthroplasty patients and surgeons were generally satisfied with telehealth and see a role for telehealth after the pandemic. Future investigations should explore how to improve telehealth physical examinations and identify which types of visits and patient concerns are reliably addressed using telehealth

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