With elective, non-essential medical and surgical care halted in New York City on March 16, 2020, due to the first COVID-19 surge, orthopaedic surgeons were forced to delay not only surgical procedures, but also in-person office visits and rehabilitation.
Hospital for Special Surgery (HSS) – like most hospitals in New York and across the country – sought to fill the gap by expanding its telehealth and telerehabilitation services. The goal was to continue providing needed care, albeit remotely, to postoperative patients.
Was this approach successful? Or did the lack of access to in-person care adversely affect outcomes, specifically early outcomes of total knee arthroplasty (TKA)?
Yes, it was successful, because no, patient outcomes did not suffer: In a study published online ahead of print by Archives of Orthopaedic and Trauma Surgery, researchers from HSS found that pausing in-person postoperative visits did not lead to a higher complication rate after TKA, nor did it affect patient-reported outcomes.
Study Methods and Findings
The outcomes of interest in this study were:
- Complications during the first 90 days after surgery
- Rate of manipulation under anesthesia within 120 days of surgery
- Patient-reported outcomes within 1 year of surgery
The study group included 624 patients who had undergone TKA for osteoarthritis and were discharged to their home between January 1, 2020, and March 15, 2020. They were matched with a control group of 558 patients who had undergone TKA between January 1, 2019, and March 15, 2019. All procedures were performed at HSS.
The researchers found that:
- Study patients were prescribed significantly fewer in-person visits and physical therapy sessions and utilized telehealth more frequently than patients in the control group
- Significantly more study patients than control patients received all their post-discharge care virtually
- The rate of 90-day complications was lower among study patients compared with the control group
- The rate of manipulation under anesthesia was similar between groups
- The rates of unscheduled outpatient visits (in-person and telehealth combined), emergency department visits, and hospital readmissions were similar between groups
- Patient-reported outcomes, including knee symptoms, pain, and function, were similar between groups at 6 weeks, 3 months, and 1 year
A Case for Fast-Track Protocols
The study findings are especially noteworthy in light of the increasing interest in “fast-track” protocols following surgery, said Geoffrey Westrich, MD, an orthopaedic surgeon at HSS and a study author. These protocols emphasize a transition of postoperative care to outpatient and in-home settings in an effort to lower costs, reduce complications, expedite recovery, and conserve hospital resources.
“In our study, reduced access to in-person care and an increased reliance on remote patient monitoring and telehealth had no major consequences on clinical outcomes for knee replacement patients,” Dr. Westrich said.
“It may be appropriate to rethink the importance of in-person follow-up, which may not always be needed. Additional research involving more patients and longer-term outcomes would be essential to confirm our findings.”
Ong CB, Cororaton AD, Westrich GH, Cushner FD, Haas SB, Della Valle AG. COVID-19 disruptions to elective postoperative care did not adversely affect early complications or patient reported outcomes of primary TKA. Arch Orthop Trauma Surg. Apr 4;1-13. doi: 10.1007/s00402-022-04422-4. Online ahead of print.