ABSTRACT
The usage of telemedicine and telehealth services has grown tremendously and has become increasingly relevant and essential. Technological advancements in current telehealth services have supported its use as a viable alternative tool to conduct visits for consultations, follow-up, and rehabilitation in total joint arthroplasty. Such technology has been widely implemented, particularly during the coronavirus 2019 (COVID-19) pandemic, to deliver postoperative rehabilitation among patients receiving total joint arthroplasty (TJA), further demonstrating its feasibility with a lower cost yet comparable clinical outcomes when compared with traditional care. There remains ample potential to utilize telemedicine for prehabilitation to optimize the preoperative status and postoperative outcomes of patients with osteoarthritis. In this review, various implementations of telemedicine within total joint arthroplasty and future application of telemedicine to deliver tele-prehabilitation in TJA are discussed.
ABSTRACT
INTRODUCTION: Total knee arthroplasty (TKA) in the elderly population is becoming increasingly prevalent. This study aimed to compare outcomes of patients aged ≥80 years with those aged < 80 years at time of TKA and to assess the effect of fast track peri-operative care on outcomes in the elderly. MATERIALS AND METHODS: 422 TKAs were performed in aged ≥80 at the time of surgery between 2009 and 2018. A control group aged < 80 years (37-79 +/- 7.6) was established. Peri-operative mortality, complications, 30-day re-admission, length of stay (LOS) and rehabilitation parameters were recorded. RESULTS: Mean age at operation for the ≥80's group and control group was 82.7 (80-93+/- 2.5) and 69.3 (37-79+/- 7.6) years respectively. Post-operative Knee Society Functional Assessment (KSFA) scores were higher in the control group (49 vs. 57, p = 0.003). Average LOS was longer in the ≥80's group (17.2 vs. 12.4 days respectively, p < 0.01). Mortality within 3 months of operation was 0.7% in the ≥80 group and 0% in the control group. Incidence of complications was comparable between the two groups at 12.8 and 12.9% for the group ≥80's and control groups respectively (p = 0.962). Patients ≥80 years, receiving fast track peri-operative care had significantly shorter LOS and higher post-operative KSFA scores at all time points post-operation and shorter LOS (p < 0.01) compared to those who received conventional rehabilitation. LOS was longer in the ≥80's group, which was likely related to higher levels of comorbidities. Complications were comparable in the two groups but were more severe in the elderly. Mortality rate after TKA was very low even in those over the age of 80. Younger patients benefited more in terms of functional improvement after TKA. CONCLUSION: TKA is a safe and efficacious procedure for the elderly. More severe complications, longer length of stay and smaller gains in functional improvement can be expected in the elderly compared to younger patients. Fast track peri-operative care is useful in improving outcomes after TKA for elderly patients.
