Z Orthop Unfall 2021; 159(01): 39-46
DOI: 10.1055/a-1289-0779
Original Article/Originalarbeit

Evaluation of the Feasibility of a Telemedical Examination of the Hip and Pelvis – Early Lessons from the COVID-19 Pandemic

Article in several languages: English | deutsch
Max Jaenisch*
Clinic and Polyclinic for Orthopaedics and Trauma Surgery, Bonn University Clinics, Bonn, Germany
,
Hendrik Kohlhof*
Clinic and Polyclinic for Orthopaedics and Trauma Surgery, Bonn University Clinics, Bonn, Germany
,
Amadeo Touet
Clinic and Polyclinic for Orthopaedics and Trauma Surgery, Bonn University Clinics, Bonn, Germany
,
Michael Kehrer
Clinic and Polyclinic for Orthopaedics and Trauma Surgery, Bonn University Clinics, Bonn, Germany
,
Davide Cucchi
Clinic and Polyclinic for Orthopaedics and Trauma Surgery, Bonn University Clinics, Bonn, Germany
,
Christof Burger
Clinic and Polyclinic for Orthopaedics and Trauma Surgery, Bonn University Clinics, Bonn, Germany
,
Dieter Christian Wirtz
Clinic and Polyclinic for Orthopaedics and Trauma Surgery, Bonn University Clinics, Bonn, Germany
,
Kristian Welle**
Clinic and Polyclinic for Orthopaedics and Trauma Surgery, Bonn University Clinics, Bonn, Germany
,
Clinic and Polyclinic for Orthopaedics and Trauma Surgery, Bonn University Clinics, Bonn, Germany
› Author Affiliations

Abstract

Introduction Due to the current COVID-19 pandemic, the German Health Ministry has issued restrictions applying to the field of orthopaedics and trauma surgery. Besides postponement of elective surgeries, outpatient consultations have been drastically reduced. Parallel to these developments, an increase in telemedical consultations has reflected efforts to provide sufficient patient care. This study aims to evaluate the feasibility of a clinical examination of the hip joint and pelvis by way of a telemedical consultation.

Materials and Methods Twenty-nine patients of a German university clinic were recruited and assessed in both telemedical and conventional examinations. Agreement between the two examinations was then assessed, and connections between the observed agreement and patient-specific factors such as age, BMI and ASA classification were investigated.

Results The inspections agreed closely with a mean Cohenʼs kappa of 0.76 ± 0.37. Palpation showed adequate agreement with a mean Cohenʼs kappa of 0.38 ± 0.19. Function showed good agreement with a mean Cohenʼs kappa of 0.61 ± 0.26 and range of motion showed adequate agreement with a mean Cohenʼs kappa of 0.36 ± 0.19. A significant positive correlation was observed between the number of deviations in the different examinations and age (p = 0.05), and a significant positive correlation was shown between the number of non-feasible examinations and age (p < 0.01), BMI (p < 0.01) and ASA classification score (p < 0.01).

Discussion Inspection and function can be reliably evaluated, whereas the significance of palpation, provocation and measurement of range of motion is limited. The small sample size puts limitations on the significance of a statistically relevant correlation between patient-specific factors such as age, BMI and ASA classification score and valid and successful implementation of a telemedical examination. The authors recommend targeted patient selection. If, however, patients are being evaluated who are very old (> 75 years), obese (BMI > 30) or with multiple comorbidities (ASA 3 and above), caution is advised. Large, prospective studies are needed in the future to fully validate telemedical consultations in the fields of orthopaedics and trauma surgery.

Conclusion A telemedical examination of the hip joint and pelvis can be performed with certain limitations. Patient-specific factors such as age, BMI, and extent of comorbidities appear to have a relevant impact on validity and execution of the examination. Patients with multiple comorbidities (ASA 3 and above), advanced age (> 75 years) or obesity (BMI > 30) should, whenever possible, be examined in a conventional outpatient setting.

* equally contributing first authors


** equally contributing last authors


Supporting Information



Publication History

Publication Date:
16 December 2020 (online)

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