Effectiveness, Patient Satisfaction, and Cost Reduction of Virtual Joint Replacement Clinic Follow-Up of Hip and Knee Arthroplasty

Abstract

Background Total hip and knee arthroplasties are increasingly performed operations, and routine follow-up places huge demands on orthopedic services. This study investigates the effectiveness, patients’ satisfaction, and cost reduction of Virtual Joint Replacement Clinic (VJRC) follow-up of total hip arthroplasty and total knee arthroplasty patients in a university hospital. VJRC is especially valuable when in-person appointments are not advised or feasible such as during the COVID-19 pandemic. Methods A total of 1749 patients who were invited for VJRC follow-up for knee or hip arthroplasty from January 2017 to December 2018 were included in this retrospective study. Patients were referred to VJRC after their 6-week postoperative review. Routine VJRC postoperative review was undertaken at 1 and 7 years and then 3-yearly thereafter. We evaluated the VJRC patient response rate, acceptability, and outcome. Patient satisfaction was measured in a subgroup of patients using a satisfaction survey. VJRC costs were calculated compared to face-to-face follow-up. Results The VJRC had a 92.05% overall response rate. Only 7.22% required further in-person appointments with only 3% being reviewed by an orthopedic consultant. VJRC resulted in an estimated saving of £42,644 per year at our institution. The patients’ satisfaction survey showed that 89.29% of the patients were either satisfied or very satisfied with VJRC follow-up. Conclusion VJRC follow-up for hip and knee arthroplasty patients is an effective alternative to in-person clinic assessment which is accepted by patients, has high patient satisfaction, and can reduce the cost to both health services and patients.

The Research on Patient Satisfaction with Remote Healthcare Prior to and during the COVID-19 Pandemic

“…Logically speaking, the review of concept and theoretical notions should take place prior to the measurement of this construct, while the analysed papers studied patient satisfaction in the reverse order. There were also papers in which satisfaction was not defined at all [43,[46][47][48][49]53,56,61,[64][65][66][67]72,80]. Taking into account both the survey questionnaires developed by the authors as well as well-defined, known, validated and reliable measures, these treat satisfaction as a multi-dimensional construct.…”

An Overview of Telehealth in Total Joint Arthroplasty

“…One study showed that virtual follow-up after TKA that consisted of a patient questionnaire and x-rays at 5 yearly intervals avoided 1814 clinic appointments, which was equal to greater than 300 hours of clinic time without compromising patient safety [17]. El Ashmawy et al [16] found that 86% of patients undergoing virtual TJA consultation reported they had saved time and/or money, with 23% saying they saved travel time and 21% reporting less wait time. A recent study conducted in Chile investigating the effect of telemedicine on efficiency and wait times found that 70% of orthopedic consultations were resolved after 2 telemedicine evaluations, and wait times for orthopedic referrals were decreased on average from 201 days to 40 days [36].…”

“…Additionally, the majority of both groups preferred telemedicine over in-clinic visits (58.8% of telemedicine group and 63.6% of standard group) [42]. A study carried out in the United Kingdom that investigated the effectiveness of a virtual joint replacement clinic found that 89% of patients were either satisfied or very satisfied with their virtual follow-up [16]. Buvik et al [9] conducted a randomized controlled trial (RCT) in Norway comparing real-time orthopedic video consultations to standard in-person visits and reported that 99% of the telemedicine group rated the encounter as very satisfactory or satisfactory.…”

“…They found that among the patients who avoided any postoperative complications (93% of study cohort), the mean savings was $656.52 per patient when using the DPE platform [39]. El Ashmawy et al [16] found that virtual TJA visits in the United Kingdom cost 56 pounds less than outpatient follow-up appointments, saving an estimated 42,644 pounds per year at their institution. A cost-analysis study conducted in Norway concluded that tele-orthopedic visits carried out at a remote clinic site with the assistance of nurses were found to be less costly than standard consultations at the hospital, with no difference in reported health outcomes [8].…”

COVID Will End But Telemedicine May be Here to Stay

“…In this issue, El Ashmawy et al. [ 1 ] report on their experience with 1749 patients who were invited to undergo a virtual follow up visit once they were more than six weeks after their hip or knee arthroplasty. The authors found that over 90% of patients utilized the virtual service at the 1 year follow up visit and only 7% of patients required an in-person visit in place of the virtual meeting.…”