Virtual clinics versus face-to-face review: Is the benefit the same for new orthopaedic patients?

BACKGROUND: COVID-19 shocked global healthcare systems, particularly the surgical services, resulting in a significant backlog of patients with waiting times not expected to return to pre-pandemic levels until 2025. The Royal College of Surgeons has recommended a wider use of virtual clinics to meet the increased demand. The efficacy of virtual follow up is well documented in the literature; however, there is very little evidence of the role of virtual clinics in the assessment of new elective patients. METHODS: Observational study comparing clinical outcomes of new patients electively referred to orthopaedic virtual clinics between January and February 2021 with face-to-face clinics in January and February 2020. RESULTS: Over the equivalent time frame, more patients were reviewed in virtual clinics compared to traditional face-to-face (821 vs 499). However, virtual clinics lead to significantly more patients being brought back for follow up (78.3% vs 37.3%) and fewer patients received outcomes that progressed their journey towards a definitive intervention or discharge. CONCLUSION: The overall benefit of virtual clinic appointments in the context of reviewing new patients remains to be proven. Despite increasing use of virtual clinics in the National Health Service, we have shown a potential delay to patients' clinical progression, ultimately delaying healthcare delivery. Potential methods to improve the benefit of virtual clinics are proposed.

Platelet rich plasma versus corticosteroid injection for plantar fasciitis: A comparative study.

INTRODUCTION: Intractable plantar fasciitis can be a difficult condition to treat. Early results of platelet rich plasma (PRP) injection have been promising. We compared PRP to traditional cortisone injection in the treatment of chronic cases of plantar fasciitis resistant to traditional nonoperative management. The aim of the study was to compare the efficacy of PRP to that of Steroid at 3, 6 and 12 months after injection. METHODS: 60 heels with intractable plantar fasciitis who had failed conservative treatment were randomised to receive either PRP or Steroid injection. All patients were assessed with the Roles-Maudsley (RM) Score, Visual Analogue Score (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Data was collected prospectively on the cohort, pre-treatment, at 3, 6 and 12 months post injection and the results were compared. RESULTS: Pre-injection, the two groups were well matched with no statistically significant difference. At 3 months, all three outcome scores had significantly improved from their pretreatment level in both groups. The scores in the Steroid arm were marginally better than in the PRP arm, but this difference was not statistically significant. At 6 months, there was no statistically significant difference between the two groups, though there was a trend for the PRP scores to become better than the Steroid scores. At 12 months, the RM, VAS and AOFAS scores in the PRP arm (1.9, 3.3 and 88.5) were significantly better than the Steroid arm (2.6, 5.3 and 75) with P values of .013, .028 and .033, respectively. CONCLUSIONS: PRP is as effective as Steroid injection at achieving symptom relief at 3 and 6 months after injection, for the treatment of plantar fasciitis, but unlike Steroid, its effect does not wear off with time. At 12 months, PRP is significantly more effective than Steroid, making it better and more durable than cortisone injection.

Tibialis anterior tendon rupture as a complication of first tarsometatarsal joint steroid injection: A case report and review of literature.

First tarsometatarsal joint steroid injection is a commonly performed procedure in foot and ankle practice. The joint is in close proximity to tibialis anterior tendon insertion. We describe a rare complication of the procedure which had to be treated surgically. We have also listed available treatment options based on literature review.

Short-term result of arthroscopic synovial excision for dorsal wrist pain in hyperextension associated with synovial hypertrophy.

INTRODUCTION: Arthroscopic excision of the hypertrophic dorsal synovium is performed on patients with dorsal wrist pain in hyperextension. Although dorsal wrist impingement has been described in cadaveric studies, to our knowledge, there is no published clinical data on its treatment with arthroscopic synovial excision. Herein, we present the results of arthroscopic management of this condition in our hospital. METHOD: A total of 13 patients underwent arthroscopic excision of the hypertrophic dorsal impinging synovium. All patients presented with the cardinal symptom of dorsal-radial wrist pain in extreme extension. The diagnoses were made after excluding other causes and confirmed on wrist arthroscopy. Arthroscopy was offered after nonoperative measures failed. The mean postoperative follow-up period was 14 (range 6-31) months. RESULTS: Mean pre- and postoperative quick Disabilities of the Arm, Shoulder and Hand scores were 49 (range 34-82) and 17 (range 0-48), respectively; paired t-test revealed a significant difference between the two (p < 0.001). Mean postoperative flexion-extension arc and radial-ulnar deviation arc were 120º and 46º, respectively. Postoperatively, one patient developed complex regional pain syndrome, with tethering of the dorsal branch of the ulnar nerve, which required surgical release, while another patient required revision arthroscopic excision of the impinging tissue. Both patients had good postoperative outcomes. CONCLUSION: When treating patients with dorsal wrist pain, dorsal wrist impingement caused by synovial hypertrophy should be included in the differential diagnosis. Arthroscopic excision of the impinging synovium can achieve reliable pain relief with significant functional improvement in the short term, although further research on its long-term benefits is required.

Intrarater and interrater reliability of the socket version marker in total hip replacement.

The aim of this study was to evaluate the intraobserver and interobserver variability in determining the socket version using the wire marker. 100 anteroposterior pelvis radiographs of cemented primary total hip replacements were reviewed by two orthopaedic consultants and registrars, twice. Intrarater and interrater reliability were assessed using Cohen's kappa. Intrarater kappas for junior doctors were 0.78 and 0.80, 0.73 and 0.62 for Consultants. Interrater kappas were 0.60 between the two Consultants and 0.63 between the two Junior Doctors. The kappas between Consultant A and Junior Doctor A was 0.61, between Consultant A and Junior Doctor B was 0.59, between Consultant B and Junior Doctor A was 0.53 and between Consultant B and Junior Doctor B was 0.46. Intrarater reliability was substantial for the two junior doctors and the two consultants. Interrater reliability was moderate-to-substantial between the two consultants, between the two junior doctors and between each pair of junior doctors/consultants.

Comparison of femoral stem alignment in primary total hip replacement by transtrochanteric and posterior approach.

BACKGROUND: In this study we have compared the femoral component alignment in primary cemented THR performed by a single surgeon using the same implant by trochanteric osteotomy and posterior approach in 50 consecutive cases. MATERIAL AND METHODS: The femoral component was compared in sagital and coronal planes on plane X-rays. The femoral stem position was classified as neutral, varus or valgus in the sagital plane. In the coronal plane the femoral stem was graded as neutral, stem pointing anteriorly or stems pointing posteriorly. Chi square test was used for the statistical significance of the findings. RESULTS: The number of stems in neutral position in AP radiograph (coronal plane) was 36 and 42 respectively in osteotomy and posterior approach. 6 stems were in varus/valgus angle of ≥5° in osteotomy group and 1 stem in the posterior approach group had a varus/valgus angle of ≥5° (p value 0.05). In the lateral radiograph (sagital plane) 45 and 43 stems respectively in osteotomy and posterior approach were in neutral position (p value 0.37). CONCLUSIONS: There is no statistically significant difference in the positioning of the femoral stem in the sagital plane by either trochanteric osteotomy or posterior approach to the hip. The positioning of the femoral stem in the coronal plane is better with the posterior approach as compared to trochanteric osteotomy