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ObjectiveTo evaluate the acceptability to key stake holders of a newly introduced virtual clinic follow-up pathway for hip and knee joint replacement.DesignA service evaluation comprising a questionnaire sent electronically to 115 patients and interviews with 10 individuals.SettingA newly introduced virtual clinic follow-up pathway for hip and knee replacement patients in a district general hospital.ParticipantsThe electronic questionnaire was distributed to all patients treated under the virtual clinic service over a 5-month period (n=115). Purposive sampling from volunteers among respondents, leading to semi-structured interviews with eight patients. Two orthopaedic consultants were also interviewed.InterventionConsultant review of web-based patient reported outcome measures and digital radiographs, with feedback to patients via letter, replacing face-to-face outpatient appointments for the follow-up of hip and knee joint replacement.ResultsThe response rate to the questionnaire was 40%. 44% indicated they would prefer a virtual appointment over a face-to-face consultation in future. The most common word in the free text comments was ‘good’ (n=107).Seven main themes were identified from the patient interviews: patient understanding and expectations, patient confidence, patient voice, managing deterioration of condition, patient benefit, patient satisfaction using technology and navigating the website.Two main themes were identified from the staff interviews: the adapting patient pathway and project management.Combined analysis elucidated that patients who were doing well liked the ‘click and go’ approach but those with problems were concerned about how to report these and were therefore less satisfied.ConclusionThe virtual clinic process appears to be well accepted by both patients and clinicians. However, appropriate patient selection and clear pathways of communication to address patient concerns are pivotal to success.

Twenty-five patients with documented Bennett's Fractures were reviewed five to sixteen years following injury (Mean 9.6 years). The majority of fractures affected the dominant hand and occurred in males. Twenty-two patients were managed conservatively by plaster immobilisation. At review ten patients were asymptomatic and only two had significant symptoms. Examination revealed loss of movement in the trapeziometacarpal joint of the thumb in twenty-one cases. Five of these exhibited malrotation of the thumb. Review of the post reduction radiographs revealed separation of the fragments by 1 mm or more in sixteen patients, but symptoms at follow-up could not be correlated with accuracy of reduction. Twenty-three patients had a varus angulation of the first metacarpal base which could be correlated to the initial post-reduction displacement. There was no correlation with the restriction of movement. Although metacarpal length will only be maintained by reduction of the fracture, there was little evidence that imperfect reduction leads to significant symptomatic arthritis in the long term.