Khitish Mohanty There were no statistically significant differences in convenience, confidence or satisfaction ratings with age or sex or procedure undertaken. 66% of respondents felt that this method had saved them time and 39% felt it had saved them money. 59% of respondents felt this method was worse than a usual clinic appointment and only two patients (4%) felt it was better. 57% of patients felt they were missing out on something by not seeing their surgeon face-to-face. Overall 75% of patients preferred to have future appointments face-to-face, 11% would prefer telephone, 13% would prefer a video call and 2% would prefer a web-based questionnaire, (Figure 4) Khitish Mohanty.
The mean age of patients preferring face-to-face appointments (65.8) had a trend to be lower than that of those preferring other virtual methods (70.3), Khitish Mohanty however this did not reach statistical significance with p= 0.072. Some key quotations from free text answers are shown in Figure 5.
Discussion Hip and knee arthroplasty numbers continue to grow with over 100,000 of each performed each year in 20161. This continues to put a significant burden on the healthcare system which is under ever increasing pressure to provide cost effective solutions Khitish Mohanty. The British Orthopaedic Association have published guidance suggesting follow-up in person at six weeks post-operatively for hip and knee arthroplasty, followed by a ‘virtual appointment’ at one year2,3. These virtual appointments have been shown to have high patient satisfaction rates4 and safety5. Due to the introduction of social distancing and cancellation of non-essential services it was necessary to perform virtual follow-up at the six week stage for a cohort of patients in our unit. These were patients that underwent their elective arthroplasty surgery in the six weeks prior to the cessation of services on the 15th of March due to COVID-19. This gave us a unique insight into the feasibility and acceptance of a virtual clinic appointment for the first appointment after surgery at six weeks post-operative Khitish Mohanty.
Three key themes for patient’s expectations for their six week appointment were illustrated in the survey Khitish Mohanty. Reassurance regarding their progress and guidance regarding maintaining their recovery is accomplishable by telephone conversation although some communication through body language and gesturing may be lost. A visual inspection of the wound and joint is however impossible to achieve through a telephone consultation alone Khitish Mohanty. We had to rely on patients’ description and their own concerns about the wound and where there was any doubt then a face-to-face appointment would have to be made. Another important aspect of an early appointment is to monitor rehabilitation and regaining of strength and mobility of the operated limb. It is not feasible to assess the muscle weakness, range of motion and strength of the joint virtually Khitish Mohanty. Similarly leg length assessment and institution of remedial measures like shoe raise and physiotherapy would be very difficult by any virtual settings Khitish Mohanty.