Telehealth may be valid for evaluating symptomatic patients for revision TJA
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Key takeaways:
- Telehealth may be valid for evaluating patients with symptomatic total joint arthroplasty.
- Instability could not be easily evaluated with telehealth in patients with symptomatic total knee arthroplasty.
SAN FRANCISCO — Results presented here showed use of telehealth may improve in-office efficiency and evaluation, and improve access to health care among patients with symptomatic total joint arthroplasty.
Rex Lutz, DO, and colleagues reviewed clinical records, radiographs, lab values, assessment plans and indications for revision surgery among 381 patients with symptomatic total hip (n=152) or knee (n=229) arthroplasty.
“All encounters were reviewed by an arthroplasty surgeon specifically within 15 years of revision experience, and then we assessed whether it was feasible for telehealth to be accurate in identifying and evaluating the problem that this patient was having,” Lutz, an orthopedic surgery resident at Jefferson Health New Jersey, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.
Overall, 36% of patients were indicated for revision THA and 43% of patients were indicated for revision TKA, according to Lutz. He said loosening and osteolysis in patients with previous TJA could be accurately identified through imaging, while prosthetic joint infection could be identified through labs and history.
“Trunionosis can be evaluated through advanced imaging and labs, and periprosthetic fractures can be identified through imaging,” Lutz said.
For evaluation of TKA, Lutz said arthrofibrosis could be diagnosed through history and a physical exam through telehealth. He added that extensor mechanism injury or disruption could be diagnosed through history and imaging, and patella tracking could be diagnosed through history.
Although instability for THA could be evaluated through history, Lutz said instability for TKA, which made up 46% of patients, could not “readily be ascertained through telehealth.”
“We did determine that a physical exam was needed for this patient population,” Lutz said.
Ultimately, Lutz said telehealth was effective at evaluating for revision surgery in 100% and 53% of patients with symptomatic THA and TKA, respectively.
“Telehealth may be a valid option when evaluating these patients with symptomatic total joint arthroplasty,” he said.
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Lutz R, et al. Paper 299. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Feb. 12-16, 2024; San Francisco.
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