Routine Radiographs After Total Joint Arthroplasty: Is There Clinical Value?

BackgroundRoutine radiographs have historically been obtained during routine care after total joint arthroplasty (TJA). However, substantial improvements in surgical technique, biomaterials, and changes in payment models placing greater emphasis on value have occurred. Recently, there has been interest in a transition to performing follow-up visits virtually. The purpose of this study was to assess how frequently patients attend postoperative appointments and the clinical utility of routine radiographs after TJA.MethodsPatients undergoing primary total hip arthroplasty and total knee arthroplasty at a single tertiary institution in 2018 were included. Patients attending scheduled follow-up at 6 to 12 weeks and 1 year were assessed. Retrospective chart review was conducted to determine whether abnormalities were noted on routine radiographic surveillance by the orthopedic surgeons or radiologist and if any radiographic findings altered clinical management.ResultsA total of 938 TJAs were performed, and 885 met inclusion criteria, with 423 (47.8%) total hip arthroplasties and 462 (52.2%) total knee arthroplasties. Eight hundred sixty-five (97.7%) patients attended a follow-up visit at 6 or 12 weeks and 589 (66.6%) attended at 1 year postoperatively. A single radiographic abnormality was detected, occurring at the 6- to 12-week period by the radiologist and interpreted as being an artifact by the surgeon. No additional radiographic abnormalities were detected at 1 year. Information from radiographs did not change clinical management for any patients.ConclusionIn a large cohort of patients, routine radiographic surveillance did not detect any true abnormalities during the first year after primary TJA. For patients without symptoms attributable to the TJA prosthesis, conducting virtual care visits without routine radiographs may be considered.     

Satisfaction With the Process vs Outcome of Care in Total Hip and Knee Arthroplasty

BackgroundPatient satisfaction, with both process of care and outcome of care, is critical for measuring the quality and value of elective procedures such as arthroplasty. The purpose of this study is to evaluate the correlation between early postoperative satisfaction with the process of care and 2-year satisfaction with the outcome of care after total hip arthroplasty (THA) and total knee arthroplasty (TKA).MethodsWe retrospectively analyzed data from institutional arthroplasty registries. Satisfaction with the outcome of care was measured on a scale of 0-100 by a previously validated questionnaire administered 2 years postoperatively. Patient satisfaction with the process of care was measured by the Press Ganey (PG) inpatient survey, also scored 0-100. We examined the correlation between these 2 measures of satisfaction in patients who underwent primary THA or TKA.ResultsIn total, 721 TKA patients and 760 THA patients underwent surgery and completed both the PG survey and 2-year satisfaction questionnaire. The mean age was 65.1 years with a mean body mass index of 28.8 and 56% were female. The mean PG survey score for the entire cohort was 95.6. The mean 2-year satisfaction score was 90.3. The Spearman correlation coefficient between the PG survey and the 2-year satisfaction survey was 0.23 for TKA patients (P < .001) and 0.13 for THA patients (P < .001).ConclusionWe found a weak correlation between the measurement of satisfaction with the process of care surrounding hip and knee arthroplasty using the PG survey and measurement of satisfaction with the outcome of care after arthroplasty using a validated 2-year satisfaction instrument.     

Cost analysis on virtual clinic follow-up after primary joint arthroplasty

BackgroundAs 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).MethodsWe 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.ResultsThis 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.ConclusionsVC 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.     

The effect of obesity on the outcome of hip and knee arthroplasty

The aim of this study was to evaluate the outcome of joint arthroplasty in obese and non-obese patients. We reviewed 2,026 consecutive primary total hip and 535 primary total knee arthroplasties performed for osteoarthritis. Patients were separated into two groups according to their body mass index (BMI): non-obese (BMI < 30) and obese (BMI ≥ 30). Their survivorships were compared. Case controlled studies were performed with 134 hip and 50 knee arthroplasties in obese patients. Each was matched individually with a control and their outcome compared. Log rank tests for equality of survival showed no difference in the survival for hip and knee arthroplasty at 11 and ten years, respectively. The obese group had significantly lower postoperative hip and knee scores at latest follow-up, especially in the range of motion. Overall patient satisfaction scores were comparable. There were no significant differences in the radiographic analysis of both hip and knee implants. Revision was used as an end point for the survival analysis. Functional scores (Harris hip score and Hospital for Special Surgery knee score), satisfaction for surgery and radiographic features were used as outcome measures for comparison. The mid-term survival of total hip and knee arthroplasty is not adversely affected by obesity. Despite lower clinical scores, the obese patients were satisfied with the results of their surgery and have an equivalent mid-term survival rate. It would be unreasonable to deny patients arthroplasty surgery purely on the basis of a BMI indicating obesity.     

Electrolyte imbalance after total joint arthroplasty: risk factors and impact on length of hospital stay

Background

Clinical as well as subclinical hyponatremia is frequently seen after orthopedic surgery. The study was aimed to determine the frequency and severity of hyponatremia in a cohort of total joint arthroplasty cases and identify the risk factors and their impact.

Methods

This is a retrospective observational study of 546 consecutive cases of total joint arthroplasty patients from a single institution. Only primary hip and knee replacements were included. The study was approved by the institutional review board. Preoperative and postoperative serum electrolytes were recorded till 45-day review. This was correlated with the age, gender, BMI, drug intake, and comorbidities.

Results

We identified 84.9% postsurgical hyponatremia in our cohort. Of these 80% were mild, 16% moderate and 4% severe. Preoperative hyponatremia was a consistent finding in most severe cases. Thaizides, ACE inhibitors, and longer surgeries like bilateral TKRs had more hyponatremia. Hospital stay was not impacted in this study for reasons discussed. There were no deaths in this series during the follow-up period, but two patients were rehospitalized.

Conclusion

Postsurgical hyponatremia occurs in up to 85% of primary hip and knee arthroplasty patients. The most consistent predictor of severe electrolyte disturbance postsurgery is preoperative hyponatremia. Older age, female gender, longer surgery, and drugs like thiazides and ACE inhibitors seemed contributory.

     

Effects of changes in whole-body alignment on ipsilateral knee pain after total hip arthroplasty

BackgroundTotal hip arthroplasty decreases hip pain and often reduces knee pain in patients with hip osteoarthritis. Whole-body alignment may be associated with knee pain, but to our knowledge this relationship has not been previously investigated. The purpose of this study was to investigate the effect of changes in whole-body alignment on ipsilateral knee pain in patients after total hip arthroplasty.MethodsIn total, 94 patients with unilateral hip osteoarthritis who underwent total hip arthroplasty were enrolled in this study. A visual analog scale (VAS) was used to investigate perioperative knee pain. An EOS 2D/3D X-ray system was used to quantify the whole-body alignment of the spine, pelvis, and lower extremities in the standing position. The relationship between perioperative changes in knee pain and whole-body alignment was investigated.ResultsAmong 61 patients who had preoperative ipsilateral knee pain, pain resolved in 30 (50%) and persisted in 31 (50%) after surgery. In these patients, average ipsilateral knee pain decreased significantly after surgery, from 41 mm to 14 mm on the VAS (P < 0.01). Preoperative knee pain was correlated with femorotibial rotation, and postoperative knee pain was correlated with K-L grade, preoperative knee pain visualized analog scale, and preoperative sagittal vertical axis. Multiple linear regression identified preoperative sagittal vertical axis as significantly associated with residual postoperative ipsilateral knee pain.ConclusionsIpsilateral knee pain decreased in half of patients after total hip arthroplasty. Patients with a considerable forward-bent posture may have residual ipsilateral knee pain after total hip arthroplasty.     

Clinically Asymptomatic Patients Show a High Bacterial Colonization Rate of Osteosynthetic Implants Around the Knee but Not the Hip

BackgroundPatients with osteosynthetic implants around the hip and knee show higher infection rates after joint arthroplasty. Our aim was to evaluate the bacterial colonization of any osteosynthetic implants around the hip and knee in patients without clinical signs of infection.MethodsConsecutive patients with osteosynthetic implant removal because of related soft tissue irritations or before elective total joint arthroplasty of the hip and knee were prospectively included. Patients with signs of infection were excluded. Based on sonication fluid cultures, implants were classified according to microbial growth as negative (no growth), contaminated (nonsignificant growth), or colonized (significant growth).ResultsSonication cultures were positive in 54 of 203 implants (27%), including 8 of 34 (24%) after orthopedic and 46 of 169 (27%) after traumatological surgery. Of 203 sonication cultures, 22 (11%) grew significant bacterial counts. Most common microorganisms were coagulase-negative staphylococci (46%). Implants around the knee showed a significantly higher rate of positive sonication cultures compared with those around the hip (14% vs 2%, P = .017).ConclusionsWe detected high bacterial implant colonization rates regardless of the initial type of surgery. Predominant pathogens were staphylococci, the most common causative agents of periprosthetic joint infections. Positive sonication results do not necessarily lead to postoperative surgical complications and thus do not equal infection. It remains unclear if patients with evidence of bacterial implant colonization show a higher risk of periprosthetic joint infection after adjacent subsequent total joint arthroplasty. Nevertheless, surgeons should be aware of a significantly higher colonization rate of implants around the knee and take this into consideration when total knee arthroplasty is scheduled in patients with osteosynthetic devices.     

Monitoring Surgical Incision Sites in Orthopedic Patients Using an Online Physician-Patient Messaging Platform

BackgroundPrompt identification and treatment of wound complications is essential after joint arthroplasty, but emergency department and office visits for urgent evaluation of normal incisions are a source of unnecessary cost. The purpose of this study is to evaluate the use of an online image messaging platform for remote monitoring of surgical incision sites.MethodsWe conducted a retrospective review of 1434 hip and knee arthroplasty patients who registered for an online platform in the perioperative period. We reviewed images sent by patients to evaluate potential wound abnormalities. Medical records were reviewed to determine whether assessments based on wound photographs corresponded with subsequent in-person findings and ultimate disposition.ResultsFour hundred thirty patients (42%) sent at least one text or image message to their provider. Elimination of redundant images resulted in 104 image encounters, with 76 discrete encounters in 41 patients related to the surgical wound. Most showed normal wound appearance; patients were reassured and urgent visits were avoided. At scheduled in-person follow-up, none of these patients demonstrated unrecognized wound complications. Seventeen image encounters in 7 patients showed possible wound abnormalities. These prompted in-person follow-up on average less than 1 day later for 4 issues deemed urgent (2 patients received surgical treatment) and 5 days later for issues deemed nonurgent. Photos were also used to monitor abnormal wounds over time and to send information unrelated to wounds.ConclusionUtilization of an online physician-patient messaging platform can prevent unnecessary visits for normal appearing wounds, while facilitating rapid in-person treatment of wound complications.     

Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty

BACKGROUND: There is limited information about the frequency of perioperative complications after elective primary orthopedic total hip and knee arthroplasty in contemporary practice. The purpose of this study was to determine the frequency of clinically relevant myocardial infarction, pulmonary embolism, deep venous thrombosis, and death within 30 days after elective primary hip or knee arthroplasty treated according to contemporary perioperative management. METHODS: The authors examined the medical records of consecutive patients undergoing hip or knee arthroplasty at their institution in a 10-yr period. Prospectively collected databases were used to identify patients with the diagnosis of myocardial infarction, pulmonary embolism, deep venous thrombosis, or death using strict validation criteria and diagnostic-certainty categories. RESULTS: A total of 10,244 patients underwent primary total hip or knee arthroplasty in the period of study. Of these, 224 patients had one or more adverse events (overall event rate: 2.2%; myocardial infarction: 0.4%; pulmonary embolism: 0.7%; deep venous thrombosis: 1.5%; death: 0.5%). Most adverse events (myocardial infarction, pulmonary embolism, and death) increased in frequency with older age, particularly for patients aged 70 yr or older. Myocardial infarction occurred more frequently in male patients. There were no differences in the overall event frequency between types of procedure. However, pulmonary embolism was highest in patients undergoing bilateral knee operations. CONCLUSIONS: The overall frequency of serious complications within 30 days after primary total hip or knee arthroplasty with contemporary practice was 2.2%. Accurate knowledge of the perioperative risks associated with widely performed elective operations can be used to implement management strategies that may further improve patient outcomes and decrease cost.     

Patient perspective survey of total hip vs total knee arthroplasty surgery

A 42-item survey was developed and administered to determine patient perception of and satisfaction with total hip arthroplasty (THA) vs total knee arthroplasty (TKA). A total of 153 patients who had both primary THA and TKA for osteoarthritis with 1-year follow-up were identified. Survey response rate was 72%. Patients were more satisfied with THA meeting expectations for improvement in function and quality of life (P < .05), whereas pain relief expectations were equivalent. Most patients (70.9%) reported that TKA required more physiotherapy. One-year Oxford score and improvement in Oxford score from preoperative to 1 year were superior for THAs (P = .000). Despite equivalent pain relief, THAs trend toward higher satisfaction compared with TKAs. THA is more likely to "feel normal" with greater improvement in Oxford score. Recovery from TKA requires more physiotherapy and a longer time to achieve a satisfactory recovery status. Patients should be counseled accordingly.     

Feasibility,Effectiveness and Costs Associated with a Web-Based Follow-Up Assessment Following Total Joint Arthroplasty

The purpose of this study was to assess the feasibility, effectiveness and costs of a web-based follow-up compared to in-person assessment following primary total hip or total knee arthroplasty. Patients who were at least 12 months postoperative were randomized to follow-up method. We excluded patients who had revision surgery, osteolysis, complications or identified radiographic issues. 229 patients (118 Web, 111 in-person) completed the study. There were no patients who had an issue missed by the web-based follow-up. Patients in the web-based group travelled less (28.2 km vs 103.7 km, (P < 0.01)), had lower associated costs ($10.45 vs $21.36, (P < 0.01)) and took less time to complete (121.7 min web vs 228.7 min usual). Web-based follow-up is a feasible, clinically effective alternative with lower associated costs than in-person clinic assessment.     

Patient-reported outcomes after total hip and knee arthroplasty: comparison of midterm results

The aim of this study was to compare the midterm functional outcomes of total knee arthroplasty (TKA) and total hip arthroplasty (THA). A cross-sectional postal audit survey of all consecutive patients who had a primary joint replacement at one orthopedic center 5 to 8 years ago was conducted. Participants completed an Oxford hip score or Oxford knee score, which are self-report measures of functional ability. Completed questionnaires were returned from 1112 THA patients and 613 TKA patients, giving a response rate of 72%. The median Oxford knee score of 26 was significantly worse than the median Oxford hip score of 19 (P < .001). In conclusion, TKA patients experience a significantly poorer functional outcome than THA patients 5 to 8 years postoperatively.     

牛津膝关节评分与膝关节单髁置换术术后满意度的相关性研究

目的:比较手术前后牛津膝关节评分与膝关节单髁置换术后患者满意度的相关性以及确定不同满意度对应的牛津膝关节评分阈值。方法:选取2017年1月至2018年6月行膝关节单髁置换术患者88例,其中男24例,女64例;年龄52～77(65.39±7.33)岁。所有患者在术前和术后6个月完成牛津膝关节评分问卷以及满意度调查问卷。采用Spearman秩相关检验分析比较牛津膝关节评分和满意度之间的相关性,以满意度为金标准,绘制ROC曲线判断手术前后牛津膝关节评分对患者满意度的评判价值,并计算约登指数探索其最佳阈值。结果:术前牛津膝关节评分和满意度之间无明显相关性(r=-0.058,P0.05);术后牛津膝关节评分和满意度之间呈中度正相关(r=0.51,P0.05),即术后牛津膝关节评分越高,患者满意度越高。术前牛津膝关节评分的ROC曲线下面积为0.55[95%CI(0.40,0.70),P0.05],无统计学意义;术后牛津膝关节评分的ROC曲线下面积为0.95[95%CI (0.90,0.99),P0.05],有统计学意义。术后牛津膝关节评分阈值为35.5时,评判满意度的敏感度为0.86,特异度为1.00,约登指数最大,为0.86。以35.5分为阈值比较高分组与低分组患者满意率,差异有统计学意义(P0.001)。结论:术前牛津膝关节评分与膝关节单髁置换术后患者满意度相关性差,其在预测患者满意度方面不具有准确性,术后牛津膝关节评分与患者满意度具有明显相关性,术后牛津膝关节评分在35.5分及以上的患者可认为对手术效果满意。同时,结果证实牛津膝关节评分在对全膝关节置换术和膝关节单髁置换术后患者主观满意度的评价具有相同的阈值。     

Enhanced recovery after surgery (ERAS) in hip and knee replacement surgery: description of a multidisciplinary program to improve management of the patients undergoing major orthopedic surgery

Enhanced recovery after surgery (ERAS) protocols aim to develop peri-operative multidisciplinary programs to shorten length of hospital stay (LOS) and reduce complications, readmissions and costs for patients undergoing major surgery. The aim of this study is to evaluate the effects of an ERAS pathway for total hip (THR) and knee (TKR) replacement surgery in terms of length of stay, incidence of complications and patient satisfaction. Patients scheduled for hip and knee replacement were included in the study. The main aspects of this program were preoperative education/physical therapy, rational choice of the anesthetic technique, optimization of multimodal analgesia, reduction of incidence of urinary retention and catheterization, active management of risk for blood loss and deep vein thrombosis, and early mobilization of the patients. All patients had 6 months predicted and planned follow-up appointments. Primary outcomes of the study were the mean LOS, readmission and complication rates. Secondary Outcomes were percentage of Knee Injury & Osteoarthritis Outcome Score (KOOS) and Hip disability and Osteoarthritis Outcome Score (HOOS) increase and patient’s satisfaction. We consecutively enrolled 207 patients who underwent total joint arthroplasty, 78 hip and 129 knee joint replacements. The mean length of stay (LOS) for patients of the two groups was 4.3 days for ASA 3-4 patients subjected to TKR and THR, in ASA 1-2 patients 3.6 days for TKR and 3.9 days for THR respectively. Postoperative satisfaction level was higher than 7 (very satisfied) in 94.4% of the cases. All patients were discharged home: 61.8% continued physical therapy in complete autonomy, 23.7% supported by a home-physiotherapist and only 14.5% needed the attendance to a physiotherapy center on a daily basis. The overall incidence of major complications was 3.4%. The implementation of an ERAS program for hip and knee replacement surgery allows early patient’s discharge and a quick return to independency in the daily activities. IV.     

New Joints,Same Old Weight: Weight Changes After Total Hip and Knee Arthroplasty

Obesity is a well-known risk factor for postoperative complications following total joint arthroplasty. However, because the operation is often successful, orthopedic surgeons continue to operate on obese individuals, and many surgeons do so under the assumption that patients will lose weight after they are able to walk and exercise without pain. In this article, we review a recent study by Ast et al., who performed a retrospective review, using a single-center institutional registry, to determine (1) whether patients do actually lose weight after total hip and/or total knee arthroplasty, (2) whether there are predictors of postoperative weight change, and (3) whether postoperative weight changes affect patient-reported clinical outcomes. The principle conclusion was that most patients maintained their body mass index (BMI) after total hip and total knee arthroplasty (73 and 69%, respectively). However, patients undergoing total knee arthroplasty, patients who had a higher preoperative BMI, and female patients were more likely to lose weight postoperatively. When examined in the context of the current literature, this study provides valuable information for the preoperative counseling of total joint arthroplasty candidates, especially in the setting of obesity.     

Frequency of Myocardial Infarction, Pulmonary Embolism, Deep Venous Thrombosis, and Death following Primary Hip or Knee Arthroplasty

Background: There is limited information about the frequency of perioperative complications after elective primary orthopedic total hip and knee arthroplasty in contemporary practice. The purpose of this study was to determine the frequency of clinically relevant myocardial infarction, pulmonary embolism, deep venous thrombosis, and death within 30 days after elective primary hip or knee arthroplasty treated according to contemporary perioperative management.

Methods: The authors examined the medical records of consecutive patients undergoing hip or knee arthroplasty at their institution in a 10-yr period. Prospectively collected databases were used to identify patients with the diagnosis of myocardial infarction, pulmonary embolism, deep venous thrombosis, or death using strict validation criteria and diagnostic-certainty categories.

Results: A total of 10,244 patients underwent primary total hip or knee arthroplasty in the period of study. Of these, 224 patients had one or more adverse events (overall event rate: 2.2%; myocardial infarction: 0.4%; pulmonary embolism: 0.7%; deep venous thrombosis: 1.5%; death: 0.5%). Most adverse events (myocardial infarction, pulmonary embolism, and death) increased in frequency with older age, particularly for patients aged 70 yr or older. Myocardial infarction occurred more frequently in male patients. There were no differences in the overall event frequency between types of procedure. However, pulmonary embolism was highest in patients undergoing bilateral knee operations.     

Intrathecal morphine for postoperative analgesia: a randomized, controlled, dose-ranging study after hip and knee arthroplasty

In this series, we examined analgesia and side effects of intrathecal morphine sulfate (ITMS) after hip and knee arthroplasty over a dose range of 0.0-0.3 mg. Eighty patients undergoing hip (n = 40) or knee (n = 40) arthroplasty were randomized to receive ITMS (0.0, 0.1, 0.2, or 0.3 mg). A patient-controlled analgesia (PCA) device provided free access to additional analgesics. Morphine use, pain relief, and side effects were recorded for 24 h. Data were analyzed with analysis of variance and linear regression. After hip arthroplasty, morphine use was less in patients receiving 0.1, 0.2, or 0.3 mg of ITMS than in control patients (P < 0.05). After knee arthroplasty, ITMS did not reduce postoperative morphine requirements. Nausea and vomiting and the incidence of oxygen saturation <93% were similar in all groups. Pruritus was more common after ITMS. Patients receiving 0.2 or 0.3 mg of ITMS were more satisfied with their pain control than those receiving 0.0 or 0.1 mg after both hip and knee arthroplasty. Analgesic needs are greater after knee arthroplasty than after hip arthroplasty. We conclude that combining small-dose (0.2 mg) ITMS with PCA morphine provides good to excellent pain control in most patients after total hip or knee arthroplasty. However, PCA morphine use was reduced by the addition of ITMS only after hip arthroplasty. IMPLICATIONS: This series examined the need for supplemental analgesics, the quality of analgesia, and the incidence of side effects with intrathecal morphine sulfate (ITMS) for analgesia after hip and knee arthroplasty. Analgesic needs are greater after knee arthroplasty than hip arthroplasty. Combining small-dose (0.2 mg) ITMS with standard doses of PCA morphine provided good to excellent pain control in most patients and reduced patient-controlled analgesia morphine use after hip, but not knee, arthroplasty.     

An Overview of Telehealth in Total Joint Arthroplasty

With the increase in technological advances over the years, telehealth services in orthopedic surgery have gained in popularity, yet adoption among surgeons has been slow. With the onset of the COVID-19 pandemic, however, orthopedic surgery practices nationwide have accelerated adaptation to telemedicine. Telehealth can be effectively applied to total joint arthroplasty, with the ability to perform preoperative consultations, postoperative follow-up, and telerehabilitation in a virtual, remote manner with similar outcomes to in-person visits. New technologies that have emerged, such as virtual goniometers, wearable sensors, and app-based patient questionnaires, have improved clinicians’ ability to conduct telehealth visits. Benefits of using telehealth include high patient satisfaction, cost-savings, increased access to care, and more efficiency. Notably, some challenges still exist, including widespread accessibility and adaptation of new technologies, inability to conduct an in-person orthopedic physical examination, and regulatory barriers, such as insurance reimbursement, increased medicolegal risk, and privacy and confidentiality concerns. Despite these hurdles, telehealth is here to stay and can be successfully incorporated in any total joint arthroplasty practice with the appropriate adjustments.