Virtual encounters have experienced an exponential rise amid the current COVID-19 crisis. This abrupt change, seen in response to unprecedented medical and environmental challenges, has been forced upon the orthopaedic community. However, such changes to adopting virtual care and technology were already in the evolution forecast, albeit in an unpredictable timetable impeded by regulatory and financial barriers. This adoption is not meant to replace, but rather augment established, traditional models of care while ensuring patient/provider safety, especially during the pandemic. While our department, like those of other institutions, has performed virtual care for several years, it represented a small fraction of daily care. The pandemic required an accelerated and comprehensive approach to the new reality. Contemporary literature has already shown equivalent safety and patient satisfaction, as well as superior efficiency and reduced expenses with musculoskeletal virtual care (MSKVC) versus traditional models. Nevertheless, current literature detailing operational models of MSKVC is scarce. The current review describes our pre-pandemic MSKVC model and the shift to a MSKVC pandemic workflow that enumerates the conceptual workflow organization (patient triage, from timely care provision based on symptom acuity/severity to a continuum that includes future follow-up). Furthermore, specific setup requirements (both resource/personnel requirements such as hardware, software, and network connectivity requirements, and patient/provider characteristics respectively), and professional expectations are outlined. MSKVC has already become a pivotal element of musculoskeletal care, due to COVID-19, and these changes are confidently here to stay. Readiness to adapt and evolve will be required of individual musculoskeletal clinical teams as well as organizations, as established paradigms evolve.

Cite this article: Bone Joint Open 2020;1-6:272–280.

Introduction. Surface sensor technology provides useful information about the status of an individual's health and been available for many years, but has not been widely adopted by orthopaedic surgeons. However, its usage may be become more prominent as COVID-19 has created a shift towards telemedicine. This study reports the use of a joint specific surface sensor to remotely monitor the recovery of patients who underwent knee replacement surgery prior to the enforced stay-at-home social distancing necessitated by the COVID-19 pandemic. Methods. The study group consisted of 29 patients who underwent primary, unilateral total knee arthroplasty (TKA). A knee joint specific surface sensor (TracPatch™) was placed following surgery and kept on patients for 3 weeks postoperatively. The patients’ range of motion (ROM), exercise compliance, distance walked, pain, skin temperature, and incision appearance were monitored and transmitted electronically to health care providers. Patients were grouped by gender, age and BMI for analysis of functional outcome measurements. Results. Patients tolerated wearing the device without complications. Additionally, both patients and physicians were able to monitor patient data in real time via a mobile phone or web application. The mean maximum flexion and minimum extension did not significantly change from postoperative week 1 to postoperative week 2 and week 3. However, the mean number of steps taken increased from 4,923 steps in postoperative week 1 to 8,163 steps week 2 (p=0.01) and 11,615 steps week 3 (p<0.001) postoperatively. There were no statistically significant differences in ROM or number of steps between the different gender, age, and BMI groups. Conclusion. The use of a joint specific surface sensor that provides novel pre- and postsurgical information is a valuable addition to surgeons’ remote care capability. These devices promise to accelerate the adoption of telehealth by orthopedic surgeons

Aims. COVID-19 has changed the practice of orthopaedics across the globe. The medical workforce has dealt with this outbreak with varying strategies and adaptations, which are relevant to its field and to the region. As one of the ‘hotspots’ in the UK , the surgical branch of trauma and orthopaedics need strategies to adapt to the ever-changing landscape of COVID-19. Methods. Adapting to the crisis locally involved five operational elements: 1) triaging and workflow of orthopaedic patients; 2) operation theatre feasibility and functioning; 3) conservation of human resources and management of workforce in the department; 4) speciality training and progression; and 5) developing an exit strategy to resume elective work. Two hospitals under our trust were redesignated based on the treatment of COVID-19 patients. Registrar/consultant led telehealth reviews were carried out for early postoperative patients. Workflows for the management of outpatient care and inpatient care were created. We looked into the development of a dedicated operating space to perform the emergency orthopaedic surgeries without symptoms of COVID-19. Between March 23 and April 23, 2020, we have surgically treated 133 patients across both our hospitals in our trust. This mainly included hip fractures and fractures/infection affecting the hand. Conclusion. The COVID-19 pandemic is not the first disease outbreak affecting the UK, nor will it be the last. The current crisis has necessitated rapid development of new hospital guidelines and early adaptive strategies in our services. Protocols and directives need to be formalized keeping in mind that COVID-19 will have a long and protracted course until a definitive cure is discovered

BACKGROUND. Telerehabilitation has been shown to both promote effective recovery after shoulder arthroplasty and may improve adherence to treatment. Such systems require demonstration of feasibility, ease of use, efficacy, patient and clinician satisfaction, and overall cost of care, and much of this data has yet to be provided. Few augmented reality rehabilitation approaches have been developed to date. Evidence suggests augmented reality rehabilitation may be equivalent to conventional methods for adherence, improvement of function, and relief of pain seen in these musculoskeletal conditions. We proposed that the development of an augmented reality rehabilitation platform during the pre and postoperative period (including post-shoulder arthroplasty) could be used to track patient activity and range of motion as well as promote recovery. METHODS. A prototype augmented reality platform equipped with a motion sensor system optimised for the upper arm was developed to be used to validate 4 arcs of shoulder motion and complete directed upper arm exercises designed for post-shoulder arthroplasty rehabilitation was built and tested. This system combined augmented reality instructions and motion tracking to follow patients over the course of their therapy, along with a telehealth patient-clinician interface. FINDINGS. The augmented reality platform was tested to validate shoulder range of motion examination similar to that of standard goniometer measurements. Healthy test subjects without shoulder pain or prior shoulder surgery performed the arcs of motion for 5 repetitions as part of a home therapy program. Each motion was measured with angular measurements as a proof of concept with high degree precision (less than 5 degrees). Remote patient-clinician interface testing was also conducted along with a clinician established therapy plan. DISCUSSION. Augmented reality systems that track patients' complex movements, including clinical shoulder range of motion, suggest the promising future of telerehabilitation in arthroplasty, particularly in telemonitoring before and after surgery. As this technology continues to gain acceptance, further studies that evaluate the outcomes of augmented reality rehabilitation for long-term follow-up are needed

Aims

This study assesses patient barriers to successful telemedicine care in orthopaedic practices in a large academic practice in the COVID-19 era.

Aims

The purpose of our study was to determine which groups of orthopaedic providers favour virtual care, and analyze overall orthopaedic provider perceptions of virtual care. We hypothesize that providers with less clinical experience will favour virtual care, and that orthopaedic providers overall will show increased preference for virtual care during the COVID-19 pandemic and decreased preference during non-pandemic circumstances.