Telehealth in Orthopedic Sports Medicine: A Survey Study on Patient Satisfaction and Experience.

Background: Telehealth has seen breakthroughs in many fields of medicine, but utilization remains limited in orthopedic sports medicine. The purpose of this investigation was to compare patient satisfaction, duration of care, and overall patient experiences with telehealth and in-person clinical visits for sports-related injuries. Methods: A cross-sectional survey study was conducted at an orthopedic sports medicine clinic during the peak of the COVID-19 pandemic between March and November 2020. Anonymous electronic surveys were used to record patient responses and statistical comparisons were drawn through two-sample t-tests. Results: A total of 175 patients (82 telehealth vs. 93 in-person) consented to participate in this investigation, and all were included in the final analysis. The overall composite satisfaction score, when compared between the two groups, did not differ (p = 0.63). Duration of care was significantly longer in the 93 patients who had in-person clinical visits as compared with the 82 patients who had telehealth visits (61/93: >31 min vs. 75/82: <30 min; p < 0.001). Finally, of the 82 patients who had telehealth, 3 respondents said they were "very unlikely" and "unlikely" to request another virtual clinical visit and/or recommend this mode of health care delivery to friends or family. Of the 93 patients had in-person clinical visits, only 15 respondents stated they were uninterested in telehealth under any circumstance. Conclusion: Most patients presenting to an orthopedic sports medicine clinic are open to telehealth, recognize its utility, and believe it to be just as comparable with in-person clinical visits. Level of Evidence: IV.

The Effect of Joint Line Elevation on Patient-Reported Outcomes After Contemporary Revision Total Knee Arthroplasty.

BACKGROUND: Joint line elevation in revision total knee arthroplasty (rTKA) is considered a risk factor for inferior outcomes, engendering a dogmatic protocol of joint line restoration. However, this precedent is based on historical data using rudimentary revision systems and unvalidated outcome measures. This study's purpose was to evaluate the effect of joint line height elevation on validated patient-reported outcome measures (PROMs) using modern revision implants. METHODS: A total of 327 rTKAs performed at a single institution were reviewed. Surgical technique prioritized flexion-extension gap balancing and accepted joint line elevation if necessary to achieve a balanced flexion space. Radiographic measurements included changes in joint line height (from preoperative and calculated "intended" anatomic/native) and change in posterior condylar offset. Prospectively collected PROMs were evaluated using multivariate regression. RESULTS: The mean joint line elevation from preoperative and "intended" to postoperative joint line was 4.9 ± 5.7 mm and 7.2 ± 6.6 mm, respectively. The mean increase in posterior condylar offset was 1.0 ± 4.6 mm. Patients within ±5 mm of preoperative joint line height were 3.88× more likely to achieve the substantial clinical benefit for Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (P = .004). An increase from intended joint line height >5 mm was not associated with differences in any other PROMs (P ≥ .165). CONCLUSIONS: In contemporary rTKA, recreating the joint line within 5 mm of preoperative improves knee-specific health outcomes. These data support approximating native joint line height as a viable technique to optimize flexion gap balance and subsequent patient outcomes in rTKA. LEVEL OF EVIDENCE: Level III retrospective cohort study.

Efficacy of a single, image-guided corticosteroid injection for glenohumeral arthritis.

BACKGROUND: Limited data are available on the efficacy of cortisone injections for glenohumeral osteoarthritis (GHOA). The amount and longevity of pain relief provided by a single cortisone injection are unclear. Additionally, it remains uncertain how the severity of radiographic GHOA and patient-reported function and pain levels impact the efficacy of an injection. Therefore, we sought to describe the relief provided by a single, image-guided glenohumeral injection in patients with GHOA. We hypothesized that patients with more severe radiographic GHOA and poorer baseline shoulder function would require earlier secondary intervention. METHODS: Patients with symptomatic GHOA who elected to receive a corticosteroid injection for pain relief were prospectively enrolled. A phone interview was conducted to record the baseline Oxford Shoulder Score (OSS) and visual analog scale (VAS) score prior to the injection, as well as the OSS and VAS score at months 1, 2, 3, 4, 6, 9, and 12 after the injection. The endpoint of the study occurred when patients required a second injection, progressed to surgery, or reached month 12. Patients were grouped by their respective baseline OSS (mild vs. moderate or severe) and Samilson-Prieto radiographic classification (mild, moderate, or severe) for analysis. RESULTS: We analyzed 30 shoulders (29 patients). Of the patients, 52% were men. The average age was 66.1 years. No significant difference in overall survival (defined as no additional intervention) was seen between groups based on either the OSS or Samilson-Prieto grade. Additionally, the OSS and VAS score at each follow-up were compared with baseline values. For the entire cohort, a clinically significant difference was seen between baseline and months 1-4 for the OSS and between baseline and months 1-4, 6, 9, and 12 for the VAS score. DISCUSSION: This study aimed to determine the efficacy of corticosteroid injections for GHOA. There were no differences in the need for secondary intervention in this population based on the severity of either the OSS or the Samilson-Prieto radiographic classification. However, patients with more severe shoulder dysfunction based on the OSS did experience statistically significantly greater symptomatic relief than patients with milder dysfunction. Additionally, following a single injection, patients in this cohort experienced statistically and clinically relevant improvements in shoulder function and pain up to 4 months after injection.

Transitioning from the Posterior Approach to the Direct Anterior Approach for Total Hip Arthroplasty.

Purpose: Total hip arthroplasty (THA) using the direct anterior approach (DAA) is known to have a learning curve. The purpose of this study was to review cases where surgery was performed by an arthroplasty surgeon transitioning from the posterior approach (PA) to the DAA. We hypothesized similar complication rates and improvements in surgical duration over time. Materials and Methods: A review of 2,452 consecutive primary THAs was conducted. Surgical duration, length of stay (LOS), surgical complications, decrease in postoperative day (POD) 1 hemoglobin, transfusion rates, POD 0 and POD 1 pain scores, incision length, leg length discrepancy (LLD), and radiographic cup position were recorded. Results: No differences in surgical duration were observed after the first 50 DAA cases. A shorter LOS was observed for the DAA, and statistical difference was appreciated after the first 100 DAA cases. There were no differences in periprosthetic fractures. A higher rate of infections and hip dislocations were observed with the PA. The PA showed an association with higher transfusion rates without significant difference in POD 1 decrease in hemoglobin over the first 100 DAA cases. Similar POD 0 and POD 1 pain scores with a smaller incision were observed for the first 100 DAA cases. The DAA cohort showed less variation in cup inclination, version, and LLD. Conclusion: DAA is safe and non-inferior in terms of reduced LOS, smaller incision, and less variation in cup position. Fifty DAA cases was noted to be the learning curve required before no differences in duration between approaches were observed.