Patient Satisfaction Is Equivalent Using Telemedicine Versus Office-Based Follow-up After Arthroscopic Meniscal Surgery: A Prospective, Randomized Controlled Trial.

BACKGROUND: Telemedicine has increasingly been considered as a viable alternative to traditional office-based health care, including postoperative follow-up visits. The purpose of the present study was to determine if patient satisfaction with overall care is equivalent for telemedicine follow-up (i.e., synchronous face-to-face video) and office-based follow-up after arthroscopic meniscectomy and repair. METHODS: Patients were prospectively enrolled from August 1, 2019, to March 1, 2020. Patients were included who were ≥18 years old, consented to isolated arthroscopic meniscal repair or meniscectomy, and were able to properly utilize telemedicine software on a computer, tablet, or smartphone with a built-in camera. Patient demographic data, including complication events and postoperative satisfaction data, were recorded and analyzed for significance. RESULTS: One hundred and fifty patients were enrolled in the study, of whom 122 (81.3%) were included in the final analysis. There were no significant differences between groups in terms of patient demographics or satisfaction scores. Patient satisfaction with overall care was equivalent based on the results of two 1-sided t-test analysis for equivalence (9.77 ± 0.60 in the office-based group versus 9.79 ± 0.53 in the telemedicine group; p < 0.001). When patients were asked to indicate their preferred follow-up type with the options listed as the type they received versus an alternative, 58 patients (84.1%) in the office-based group preferred their received type of follow-up, whereas 42 (79.2%) in the telemedicine group preferred their received follow-up (p = 0.493). There were no significant differences between groups in terms of complications (p > 0.05). CONCLUSIONS: The present study showed that patient satisfaction with overall care is equivalent between telemedicine and office-based follow-up in the immediate postoperative period following an arthroscopic meniscal surgical procedure, and should be considered a reasonable alternative to the traditional in-office modality. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Early Experience with Virtual Pediatric Orthopedics in New York CityPearls for Incorporating Telemedicine into Your Practice.

BACKGROUND: The purpose of this study was to identify and characterize challenges and benefits to the use of tele-medicine for the treatment of pediatric orthopedic patients during and after the COVID-19 pandemic. METHODS: A novel survey was sent to all faculty members at an academic pediatric orthopedic practice in New York City regarding their use of telemedicine in response to the COVID-19 pandemic. RESULTS: Faculty members performed 227 unique tele-health visits with pediatric orthopedic patients over a 7-week period in early 2020, and this formed the basis for responses to the survey. The results of the faculty survey suggest that telemedicine has substantial clinical benefits for pediatric orthopedic surgeons and our patients that extend beyond the COVID-19 pandemic. Providers recognize the limits of conducting physical exams over telemedicine and should always use clinical judgment when evaluating patients, par-ticularly trauma patients who may require prompt referral for additional care. CONCLUSIONS: The ability to provide pediatric orthopedic care through telemedicine has allowed us to safely evaluate and treat pediatric patients with musculoskeletal problems in New York City and its environs despite the COVID-19 pandemic. The efficient evaluation of both new and exist-ing pediatric orthopedic patients via telehealth is viable. Physical examination is the most challenging aspect of the physician-patient encounter to replicate virtually. Targeted educational efforts for patients and their families before the visit about what to expect and how to prepare improves efficiency with virtual pediatric orthopedic visits. Efforts to limit disparities in access to telemedicine will be needed to allow all pediatric orthopedic patients to participate in telemedicine equitably.

Vancomycin Povidone-Iodine Protocol Improves Survivorship of Periprosthetic Joint Infection Treated With Irrigation and Debridement.

BACKGROUND: Irrigation and debridement with modular component and liner exchange (IDLE) is a low morbidity procedure for treatment of periprosthetic joint infection (PJI) with reported failure rates exceeding 50%. Dilute povidone-iodine lavage has been shown to be safe and effective in decreasing acute PJI in primary total joint arthroplasty. Vancomycin powder has also shown to be effective in preventing infection in spine surgery. We hypothesize that a vancomycin povidone-iodine protocol (VIP) used in conjunction with IDLE can increase infection-free survivorship after acute PJI. METHODS: This is a single institution retrospective review of all PJIs treated with IDLE and VIP since March 2014. A consecutive matched control group of patients treated with IDLE for PJI for 2 years prior to March 2014 was also included for analysis. Primary outcome was failure, defined as return to operating room for an infection-related problem. Secondary outcome was chronic suppression with antibiotics at final follow-up. Minimum follow-up was 1 year. RESULTS: A total of 36 patients in the VIP group and 38 patients in control group were identified. In the VIP group, 16.7% (6/36) failed at final follow-up compared to 37% failure rate (14/38) in the control group (P < .05). Three patients in the VIP group were on chronic antibiotic suppression at final follow-up. There were no medical complications secondary to the VIP. CONCLUSIONS: The VIP group demonstrated a significant reduction in reinfection and failure rate following IDLE. The authors believe that a VIP is an effective adjunct for treating PJI with irrigation and debridement.