Satisfaction and feasibility of videoconsultation (VC) in orthopaedic and trauma surgery in the context of the COVID-19 pandemic: Prospective study of 783 patients.

BACKGROUND: The COVID-19 pandemic has required that specialists use videoconsultation (VC) to maintain continuity of care. As in-person consultations (IPCs) and surgical procedures were cancelled, VC became the tool of choice. No recent French study has assessed VC as the main consultation modality. The objective of this prospective study was to evaluate: 1) patient satisfaction, 2) access to and the future of VC, 3) and the reasons for VC refusal in the setting of the pandemic. HYPOTHESIS: Patients responded favourably to VC. PATIENTS AND METHOD: We conducted a prospective, single-centre, observational study of consecutive patients who were invited to switch from IPC to VC during the lockdown of March 16 to May 11, 2020, when IPCs were not available. All patients were included in the study, regardless of whether they accepted the VC. The reasons for refusal were recorded at the time of the invitation. The surgeons sent the patients who accepted an emailed satisfaction questionnaire after the VC. RESULTS: Of the 783 patients with scheduled IPCs, 291 (37.2%) accepted a VC instead, 408 (52.1%) refused the VC, and 84 (10.7%) could not be contacted by telephone and were therefore excluded. The VC acceptance rate was 37% (291/783). Of the 291 VC patients, 233 (80.1%) returned the satisfaction questionnaire, although 2 questionnaires had too many missing data to be included, leaving 231 patients for the analysis. The VC was the first consultation with the surgeon for 66 (28.6%) patients. Of the 165 (71.4%) other patients, 51.6% (85/165) were receiving post-operative follow-up. On a 0-5 scale, the global VC experience was scored 4.3±0.8. Of the 231 VC patients, 161 (69.7%) felt that the VC was equivalent to an IPC, 18 (7.8%) that it was poorer, and 7 (3%) that it was better than an IPC; 45 (19.5%) had no opinion on this point. If choosing between a VC or an IPC had been possible during this first lockdown, 168/231 (72.7%) patients would have chosen an IPC. In contrast, 198/231 (85.7%) patients said they would choose an IPC after the lockdown. The group that refused the VC had a significantly older mean age (57.8±16.4 years vs. 48.0±14.4 years, p<0.0001) and lived closer to the institution (p<0.0001), whereas the sex distribution was comparable, with 42.9% of males (175/408) refusing and 46.8% (108/231) accepting the VC (p=0.39). The main reason for refusal was a wish for an in-person encounter with the surgeon (268/408, 65.7%). Patients aged ≥65 years were more likely to refuse due to technical considerations (access to electronic equipment and to the Internet), whereas patients ≤35 years were more likely to wait for an IPC. CONCLUSION: The rate of satisfaction with the VC was high. Satisfaction was not significantly associated with the reason for the consultation (joint involved, degenerative or post-traumatic condition, first VC, first consultation, or follow-up before or after surgery). Although most patients who accepted the VC felt that this modality was equivalent to an IPC, many remained desirous of an in-person encounter with the surgeon, notably among the youngest individuals. Outside the setting of a pandemic, the IPC remains the consultation modality of choice for most of our patients. LEVEL OF EVIDENCE: V, prospective study without a control group.

Long-term comparative study of large-diameter metal-on-metal bearings: Resurfacing versus total arthroplasty with large-diameter Durom™ bearing.

INTRODUCTION: Short-term results in total hip arthroplasty (THA) with large-diameter metal-on-metal (MoM) bearings were encouraging, but high failure rates have been reported in the long term, notably implicating corrosion due to modularity. Several studies compared resurfacing (to which modularity does not apply) versus large-diameter MoM THA; but, to our knowledge, none compared the same bearing in the two situations with more than 10 years' follow-up. We therefore conducted a retrospective case-control study, using a single cup model (Durom™, Zimmer, Warsaw, USA) for both resurfacing (R) and large-diameter THA, to determine the role of modularity in failure of large-diameter MoM bearings. The study compared (1) metallic ion levels, and (2) survival, functional scores and complications rates between R and THA. HYPOTHESIS: Large-diameter MoM bearing failure implicates not bearing wear but head-neck junction modularity in larger-diameter MoM THA. MATERIAL AND METHOD: Eighty-three THAs and 90 Rs were included between February 2004 and March 2006. All patients had clinical and radiologic follow-up with chromium (Cr) and cobalt (Co) ion blood assay. RESULTS: In the THA group, 24 of the 83 patients (28.9%) underwent revision for adverse reaction to metal debris (ARMD), versus none in the R group. Ten-year all-cause survival was significantly better in R (97.7%; 95% CI, 96.2-99.2) than THA (67.1%; 95% CI, 60.9-73.3). Median blood ion level was higher in THA (with a difference between Co and Cr: 5.75µg/L (range, 3.82-19.2) versus 1.75µg/L (range, 1.34-2.94) respectively) than in R (no difference: 0.89µg/L (range, 0.67-2.89) and 1.07µg/L (range, 0.67-1.65) respectively). In the THA group, there were positive correlations between Co and Cr elevation and implant revision (both p<0.0001). Co/Cr ratio was significantly higher in THA (2.57) than R (0.88) (p<0.0001), and higher again in the 24 cases of THA revision (4.67). There was no significant difference in mean PMA score (THA: 17.08±1.82 (range, 7-18); R: 17.50±0.74 (range, 15-18)), whereas mean Oxford score was better in R (14.32±2.5 (range, 12-24)) than THA (18.17±8.05 (range, 12-42)) (p=0.02). DISCUSSION: The present study confirmed the incontrovertible implication of modularity in failure of large-diameter MoM THA, by analyzing the same bearing in THA and in resurfacing. Trunnionosis was observed in the 24 cases of revision, with the THA adaptation ring inducing serious metallic ion release (with dissociated Co/Cr ratio), accounting for the high rate of revision. LEVEL OF EVIDENCE: III, case-control study.