Joseph Vinay, Nagy Mathias T, Fountain James
Department of Trauma and Orthopaedic Surgery, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, Lancashire, WN6 9EP, United Kingdom.
Department of Trauma and Orthopaedic Surgery, Aintree University Hospital, Lower Lane Fazakerley, Liverpool, L9 7AL, United Kingdom.
J Clin Orthop Trauma. 2021 May 15;19:89-93. doi: 10.1016/j.jcot.2021.05.010. eCollection 2021 Aug.
As previously reported, a virtual clinic (VC) effectively manages the increasing need to review and monitor patients after primary joint replacement. Such procedure is increasing steadily in number, with more than 200,000 procedures performed annually in the UK. Considering that face-to-face review following routine uncomplicated primary joint arthroplasty is costly and time consuming, guidelines suggest reviewing patients at regular intervals through radiographs and patient-reported outcome measures (PROMs).
We reviewed our VC experience in a large teaching hospital. A single surgeon established the VC, and all primary hip and knee replacements over an 18-month period (January 2016 to July 2017) were included in the study. We evaluated all clinical records, PROMs, patient satisfaction, and outcome of VC at one-year follow-up. Additionally, we conducted a safety and cost analysis.
This study included 154 primary joints (70 total knee replacements and 84 total hip replacements) in 148 patients (89 females, 59 males). The mean age at surgery was 65.3 years. Of the patients, 93% completed the postoperative PROMs, whereas <40% completed the PROM during regular clinical follow-up. All the patients had follow-up radiographs. After VC assessment, which included radiographies and PROMs, 59% of the patients were directly discharged. Of the remaining 41% patients who had face-to-face review, one-third were examined for the same arthroplasty issue, and two-thirds were examined for unrelated or other joint problems. Although the postoperative PROM was below the national average, the improvement in PROM (from pre-operative to post-operative scores) was higher than the national average. The cost analysis demonstrated an average cost savings of £10.449 per year and consultant.
VC follow-up after primary joint replacement is a safe and cost-effective option to manage postoperative follow-up visits and identify those patients who require additional face-to-face reviews and who can be safely discharged. The discharge criteria included satisfactory improvement in PROM scores, review of follow-up radiographs, and no concerns raised by patients. Considering the increasing number of primary joint arthroplasty and the financial pressure on the National Health Service, VC offers an excellent alternative to conventional clinics.
如先前报道，虚拟诊所（VC）能有效应对初次关节置换术后对患者进行复查和监测需求的不断增加。此类手术数量在稳步上升，英国每年开展超过20万例。鉴于常规无并发症的初次关节置换术后进行面对面复查成本高且耗时，指南建议通过X光片和患者报告的结局指标（PROMs）定期对患者进行复查。
我们回顾了在一家大型教学医院的虚拟诊所经验。由一位外科医生建立了该虚拟诊所，研究纳入了18个月期间（2016年1月至2017年7月）所有的初次髋膝关节置换病例。我们在一年随访时评估了所有临床记录、PROMs、患者满意度及虚拟诊所的结局。此外，我们进行了安全性和成本分析。
本研究纳入了148例患者（89例女性，59例男性）的154个初次关节（70例全膝关节置换和84例全髋关节置换）。手术时的平均年龄为65.3岁。其中93%的患者完成了术后PROMs，而在常规临床随访期间完成PROM的患者不足40%。所有患者均有随访X光片。经过包括X光检查和PROMs的虚拟诊所评估后，59%的患者直接出院。其余41%进行了面对面复查的患者中，三分之一是因相同的关节置换问题接受检查，三分之二则是因不相关或其他关节问题接受检查。尽管术后PROM低于全国平均水平，但PROM（从术前到术后评分）的改善高于全国平均水平。成本分析显示，每年每位顾问平均节省成本10449英镑。
初次关节置换术后的虚拟诊所随访是管理术后随访、识别那些需要额外面对面复查以及可以安全出院患者的一种安全且具有成本效益的选择。出院标准包括PROM评分有令人满意的改善、复查随访X光片以及患者无担忧。鉴于初次关节置换手术数量的增加以及国民医疗服务体系面临的财政压力，虚拟诊所为传统诊所提供了一个极佳的替代方案。
