Remote Follow-up of Shoulder Arthroplasty Patients During COVID-19 Pandemic - Is This the way Forward?

Background

The COVID-19 Pandemic has affected the way health care systems function across the globe. Apart from eliminating the risk of being in a vulnerable environment during the pandemic such as a hospital setting, virtual arthroplasty follow-up reduces the demand on funding and resources on the National Health Services (NHS).

Methods

We retrospectively reviewed our shoulder arthroplasty patients (55) operated between October 2018 to November 2020 at both our hospital sites. For remote follow-up, patients were contacted on a scheduled appointment date via telephone by an orthopaedic surgeon to enquire about their wound, pain and function. Patients were questioned as per questionnaire from the Oxford Shoulder Score (OSS) and American Shoulder and Elbow Surgeons (ASES) Standardised Assessment form.

Results

50 patients were included in the final data set after excluding those who had died (5 patients). All patients had had final x-rays with full Covid-19 precautions at the time of final follow-up. No patient had wound problems except one who had concerns of wound appearance. There were no cases of notching, impingement, deep infection, dislocation or nerve injury. Of the 50 patients, 40 (80%) patients were satisfied to have a remote follow-up. 36 (72%) patients said they wouldn't mind a remote follow-up appointment.

Conclusion

Remote follow-up via audio consultation may be an effective alternative to in person visits after shoulder arthroplasty. Patients in this series demonstrated a high level of satisfaction with virtual visits and post-operative complications were effectively identified.

Revision Total Hip Arthroplasty Using Imageless Navigation With the Concept of Combined Anteversion

BACKGROUND

The purpose of the study was to evaluate the implant positions and clinical results of revision total hip arthroplasty (THA) using an imageless navigation with the concept of combined anteversion.

METHODS

A total of 40 cementless revision THAs (24 men and 16 women) using an imageless navigation with the concept of combined anteversion were retrospectively evaluated. The concept of combined anteversion was applied in cup positioning based on Widmer's equation (cup anteversion + 0.7 × stem anteversion). The mean follow-up period was 80.7 months. Postoperatively, the inclination of the cup was evaluated on standard anteroposterior view of the radiograph, and the anteversion of the cup and femoral stem was evaluated using computed tomography scan. A cup inclination of 40° ± 10° and combined anteversion of the cup and femoral stem of 37° ± 10° based on Widmer's equation were regarded as the "safe zone."

RESULTS

The average anteversion of the revised femoral stems was 15.3° ± 2.9° (range, 9.5°-21.5°), whereas that of the remained femoral stems was 17.4° ± 9.7° (range, 4.2°-29.8°). The inclination, anteversion of the cup, and combined anteversion after revision THA were 42.3° ± 3.1° (range, 32.1°-48.2°), 25.0° ± 2.9° (range, 16.9°-29.5°), and 36.1° ± 3.4° (range, 27.2°-42.9°), respectively. Therefore, the position of the implants, relative to the safe zone, showed no outliers after the revision surgery. Neither dislocation nor osteolysis was observed after the surgery.

CONCLUSION

Favorable results of this study indicate that imageless navigation helps the surgeon in placing the components of revision THA in the safe zone. This study also shows that when this safe zone is consistently obtained, then no postoperative dislocations were observed in these patients over the 6-year follow-up period.