Telehealth for Knee Arthroplasty

Original Editor - User Name

Top Contributors - Uchechukwu Chukwuemeka, Kim Jackson, Tony Lowe and Lucinda hampton  

Introduction

Telehealth and Telemedicine are often used interchangeably. However, both have distinct definitions. Telemedicine refers specifically to the “remote delivery of healthcare services and clinical information using telecommunications technology, such as the internet, wireless, satellite, and telephones”1. In contrast, Telehealth is defined as the “use of electronic communications to share medical information from one place to another with the intention of improving a patient’s health”2. Telemedicine focuses on the curative aspect of Telehealth that encompasses preventive, promotive, and curative models of health care system. Rehabilitation being another important model of the modern health care system, its delivery via digital platform has already been defined earlier. Telerehabilitation, one of the emerging fields of telemedicine, is defined as the set of tools, procedures, and protocols to deliver the rehabilitation process remotely3. Rehabilitation has increased its demand, increasing the cost thereby threatening the sustainability of the existing health care system. Tele-rehabilitation to some extend can assist by the early discharging of patients from points of care and improving the patient’s adherence to rehabilitation service4. Tele-rehabilitation though has a long history of practice it has been consistently advocated in the literature to be practiced routinely after the SARS COVID-19 pandemic outbreak.

The novel coronavirus was first recognized in December 2019 and its infection was declared as a global pandemic by the World Health Organization (WHO) in March 2020. WHO has instructed various measures to control its spread like social/physical distancing, area lockdown, travel restriction to the contaminated zones, workplace closure, postponement of medical visits unless it is an emergency, etc. Face to face clinical consultation is also restricted to contain the spread of infection 5-7 . This has opened a new era of teleconsultation for medical services, including rehabilitation.

Knee Arthroplasty

Knee arthroplasty is an orthopedic surgical procedure of replacing the articular surface of the knee joint. The femoral condyle(s) and tibial plateau are replaced with a metal surface with at least one polyethylene insert between them. In this procedure, patellar resurfacing may or may not be done. It is indicated in cases of severe pain that limits the activities of daily living due to end-stage osteochondral damage or osteoarthritis. A procedure with patellar resurfacing is known as total knee arthroplasty. In contrast, partial knee arthroplasty can be total (TKA) or unicompartmental (UKA) depending on the number of femoral condyle replaced8-9. UKA is bone conserving and ligament sparing procedure with enough evidence to demonstrate good medium to long term success in restoring the physical function and decreasing the pain10. A rehabilitation program with an emphasis on physiotherapy and exercises before and after the surgery is well advocated in the literature11. Studies show that early interventions of the physiotherapy program improve the physical function at least in short term after primary knee arthroplasty 12. Modern days physiotherapy in knee arthroplasty can be subdivided into three phase:

1. Preoperative phase: Including Patient education, Maintaining Knee range and strength, improving overall physical function of the patient
2. Early Postoperative Phase: Restoring range of knee motion, maintaining the strength of lower limb muscles, and participation of the patient in activities of daily living
3. Late Postoperative phase: Strength and function-specific task training,  social participation/integration

Home-based exercise after the discharge of patients from an acute hospital setting is also an evidence-based measure of improving patient adherence to the rehabilitation program and overall improvement in the outcome.

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