Experiments in Remote Orthopedic Care

In an effort to protect patients amid the COVID-19 pandemic still raging in the U.S., many doctors are relying on telemedicine to “see” their patients through video chats rather than risk a trip to the clinic. That might work for minor health problems like muscle sprains, but what happens if you break a bone or tear a ligament? Even in a pandemic, people still get injured.

Michigan Orthopaedic Surgeons clinicians, thankfully, have found a way to help with these orthopedic injuries.

“At a time like this, I think we just have to make [do] with what we have,” orthopedic surgeon Dr. Rachel Rohde told ClickOnDetroit. “We’re doing tele-health visits during the day and also after hours and on the weekends to try to do what we can do with tele-health.”

“You fall, you twist your knee, what’s going on with it? Again, it’s a little bit more difficult to do that, but you can get a sense kind of from the visit or talking to the patient how bad things are,” added orthopedic surgeon Dr. James Bicos.

But there are injuries that can’t be treated virtually.

“Things we can’t do like X-rays, casting, or even surgery, we can help coordinate so that patients don’t have to go to the emergency room or other high flow areas and try to keep them safe,” said Dr. Bicos.

The goal is to keep patients out of the ER when possible to reduce exposure risk and free up personnel to care for other patients. For example, a carpal tunnel syndrome patient can receive guidance about home care until better treatment can be arranged.

“This is new, and it’s something that we need to get out to patients, telling them that this is available, we’re open, we’re here to at least triage their complaints, and to know that they’re being listened to,” said Dr. Bicos.

In late July OrthoNOW orthopedic immediate care centers in South Florida rolled out the OrthoNOW Mobile App v3.0 for iPhone and Android. With the app, users can choose a clinic and alert that they’re on the way; track progress of injury, treatment, and healing; use telemedicine for a video visit, get post-treatment info on their phone; and many other services. v3.0 of the app adds several functions to simplify an orthopedic visit for patients. For example, On My Way NOW allows them to select a clinic, order a car from Uber or Lyft, and alert the medical team of arrival.

If you pull a muscle while playing tennis or your shoulder doesn’t feel right after waking up, the app can be a huge help.

“We have patients, coaches, and crew leaders who have the app on their phones and ready to go. You never know when you’re going to need it,” OrthoNow vice president Eric Rylander told the press.

Parents and coaches of young athletes can also input information for rapid, game-time decisions.

“The OrthoNOW app will provide guidance and information for coaches and young athletes, and for other sports enthusiasts as well, to decide when it’s time to come off of the bench and likewise, when it might be time to come off the field,” said Dr. Alejandro Badia, OrthoNOW’s founder and chief medical officer.

New patients who would normally see an orthopedic physician assistant (PA) for initial examination in Dr. William P. Barrett’s Renton, Wash., practice have been completing the initial visit via telehealth as well. Barrett told Healio Orthopedics he adopted the approach a few weeks after elective surgery was discontinued in mid-March. Patients who once saw the PA about two weeks pre-operatively to review everything now use telehealth. The first post-op visit following a total knee or hip replacement (TKR/THR) about 10 to 14 days after surgery is also being conducted via telehealth.

“There has been a change as far as the introduction of technology into orthopedics, particularly adult reconstructive practices, as far as the preoperative and postoperative to minimize the contact with the patient, for the safety of the patient,” he said.

Medical device companies are also working to assist with the explosion in telehealth use in orthopedic surgery as a result of the pandemic.

“DePuy Synthes is working to arm our surgeons with information that is built into the telemedicine solution so that when they are having a conversation with the patient, they actually have the ability to pull up materials,” said DePuy Synthes company group chair Aldo Denti. He said these materials explain what TKR and THR look like, and are all built into the protocol of that patient’s journey pre-operatively.

The company is also working on telehealth technology for the post-operative timeline. For example, there is a novel process by which the surgeon or PA can view a surgical scar via telehealth in a simpler, more streamlined way than a picture taken by the patient using a phone or camera.

“That is an area that we are actually investing in as we speak,” Denti said.