Telehealth in Orthopaedics: Expanding Access Without Compromising Quality

Pre-pandemic, orthopaedic outpatient services were almost universally delivered through face-to-face consultation — a model that has considerable clinical advantages but also significant access barriers for patients who live far from specialist centres, who cannot easily take time off work for hospital appointments, or who have mobility limitations that make hospital attendance genuinely challenging. The telehealth expansion of 2020 demonstrated that these barriers are not inherent to the delivery of good orthopaedic care — they are artefacts of a delivery model that technology can, for a substantial proportion of consultations, improve upon.

Where telehealth delivers equivalent value

Post-operative reviews — assessing wound healing, discussing patient-reported recovery progress, reviewing rehabilitation adherence, and addressing patient questions — can, in the majority of cases, be conducted effectively through video consultation at three, six, and twelve weeks after elective shoulder and upper limb surgery. The clinical information required at these time points is predominantly symptom and function-based — information that the patient provides, and that a skilled clinician can elicit and interpret through structured video consultation as reliably as in person.

New patient assessments for specific upper limb conditions — where the provisional diagnosis can be assessed with high probability from history alone, and where the video examination — range of motion assessment, functional tests, and visual inspection — provides adequate clinical information for a management plan — are appropriate for telehealth in carefully selected presentations. The clinical judgement about which new presentations are suitable for remote assessment, and which require hands-on examination, is the skill that distinguishes excellent from inadequate telehealth practice.

The equity argument for telehealth

Telehealth's most compelling argument is not efficiency — though it delivers that too. It is equity. Patients who live in rural areas, who cannot take time off work for hospital appointments, who have caring responsibilities, or who face transport barriers have historically received less accessible follow-up care than those without these constraints. Telehealth removes those barriers for the consultations where remote delivery is appropriate — and in doing so, extends the quality of specialist follow-up to patients who have historically received less of it.

The integration of remote monitoring data — wearable activity metrics, digital PROM completion, and patient-initiated symptom reporting — with telehealth follow-up creates a richer, more continuous clinical picture than scheduled face-to-face appointments alone can provide. The clinician who arrives at a video follow-up having reviewed two weeks of recovery trajectory data is better equipped to identify concerns and provide relevant advice than one relying solely on the patient's recall of how they have been feeling.