Remote Management of Patients after Total Joint Arthroplasty via a Web-Based Registry during the COVID-19 Pandemic

Abstract

Background: In 2020, due to the outbreak of the COVID-19 (Coronavirus Disease 2019) pandemic, patients who underwent total joint arthroplasty were not able to undergo the proper postoperative surgical and rehabilitative care. This study aims to evaluate the potential of a web-cloud-based database on patients’ follow-up in extraordinary situations, when a traditional in-person follow-up cannot be warranted. Methods: Patients who underwent joint arthroplasty at our Institute between 21 February and 16 March 2020 were included in the study group and were matched to a similar population undergoing joint arthroplasty in February/March 2019. All patients routinely complete questionnaires before and after treatment, including patient-reported outcome measures such as the Visual Analogues Scale (VAS), Knee/Hip Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS/HOOS-PS) and Short-Form Health Survey (SF-12) for the monitoring of clinical improvements. Results: 56 (study group) and 144 (control group) patients were included in the study. Both groups demonstrated significant improvements at 3 months. HOOS-PS improvement was significantly reduced in the 2020 group compared to 2019 (21.7 vs. 33.9, p < 0.001). This reduction was related to intense physical activities. Similarly, the functional score improvement related to these activities was reduced for patients undergoing knee replacement (8 vs. 10, p < 0.05). Conclusions: The web-based Institute Registry emerged as a meaningful and sensitive tool during an extraordinary situation such as the COVID-19 pandemic to monitor patients’ progression after total joint arthroplasties. Thanks to this tool, it was possible to observe that the prevention of usual postoperative care due to pandemic-related restrictions did not alter the benefits observed after joint replacement surgeries, even if this condition reduced the postoperative improvements in the most burdensome physical activities. A broader use of this kind of tool would improve and potentially reduce the burden and costs of postoperative patients’ monitoring in standard and extraordinary conditions. In addition, the systematic remote collection of data would allow for the identification of relevant differences in clinical outcomes in specific conditions or following the modification of treatment and rehabilitation protocols.

Global Impact of the COVID-19 Pandemic on Orthopedics and the Implications of Telemedicine: A Systematic Review of the Literature

“…Recently, more and more other studies discussed the implications of telemedicine in orthopedics from various aspects. [ 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 ].…”

COVID-19 disruptions to elective postoperative care did not adversely affect early complications or patient reported outcomes of primary TKA

“…Lastly, we found equivalent 1-year outcomes between cohorts aside from VR-12 mental and LEAS scores. A recent matched analysis by Ulivi et al involving 200 TJA patients compared PROMs between patients who underwent TJA shortly prior to COVID-19 suspensions of in-person care (2/21/20–3/16/20) to those of a control cohort 1 year prior (2/1/19–3/31/19) [ 32 ]. Among TKA patients, no significant differences in 3-month VAS pain, KOOS and SF-12 mental/physical scores were observed.…”

The use of information technology applications in the provision of health care to a COVID-19 patients

“…In addition, many of those patients lost their lives, which frightened the population. From the foregoing, it was necessary to suggest some solutions to these problems resulting from this pandemic and to mitigate its effects on patients with this virus in particular [8]. In this research paper, an accurate review of the sources related to providing medical and clinical services remotely during the Corona pandemic period was used, and these sources varied from scientific reports, conference proceedings, and scientific papers published in international journals that were cited in the references section.…”