Integrating wearables and modelling for monitoring rehabilitation following total knee joint replacement

Efficacy and safety of continuous nursing in improving functional recovery after total hip or knee arthroplasty in older adults: A systematic review

Objective

This systematic review was conducted to evaluate the efficacy and safety of continuous nursing care for the recovery of joint function in older adults with total hip or knee arthroplasty.

Methods

Randomized controlled trials and cohort studies of continuous nursing in older patients after joint replacement were searched from the database of Cochrane Library, Web of Science, PubMed, and Embase from their establishment to October 25, 2023. After literature screening, two researchers completed data extraction, and the risk of bias was assessed using the Cochrane risk-of-bias tool. The risk analysis included in cohort studies was based on the Newcastle-Ottawa Scale (NOS).

Results

The study included a total of 15 articles, comprising 34,186 knee and hip replacement patients. In this review, the effects of continuous nursing on the recovery of joint function of knee replacement and hip replacement in older adults were classified and discussed. Continuous nursing interventions targeted for total hip replacement could greatly increase the range of joint mobility, enhance muscle strength during hip movements like flexion, extension, and abduction, maintain joint stability, relieve pain, improve daily activities, and lower the risk of complications. For older patients with knee arthroplasty, continuous nursing programs could markedly improve knee motion range, joint flexion, joint stability, daily activities, and pain management. Despite the implementation of interventions, the incidence of complications caused by total knee replacement did not decrease. Out of all the studies reviewed, only one used a theoretical framework for interventions provided to patients during the postoperative period of hip arthroplasty. The overall quality of the included studies was very high.

Conclusion

Continuous nursing can effectively improve the joint function of older patients after joint replacement. However, its effectiveness in terms of clinical outcomes, patient satisfaction, and medical cost of associated continuous nursing needs to be further clarified. In addition, continuous nursing has no significant advantage in the safety of postoperative complications and readmission rates in older adults after knee joint replacement. To enhance the efficacy and safety of continuous nursing effectively, it is crucial to refine the continuous nursing program in the future, thereby elevating the quality of nursing services.

Intelligent prediction of lower extremity loadings during badminton lunge footwork in a lab-simulated court

Introduction: Playing badminton has been reported with extensive health benefits, while main injuries were documented in the lower extremity. This study was aimed to investigate and predict the knee- and ankle-joint loadings of athletes who play badminton, with "gold standard" facilities. The axial impact acceleration from wearables would be used to predict joint moments and contact forces during sub-maximal and maximal lunge footwork. Methods: A total of 25 badminton athletes participated in this study, following a previously established protocol of motion capture and musculoskeletal modelling techniques with the integration of a wearable inertial magnetic unit (IMU). We developed a principal component analysis (PCA) statistical model to extract features in the loading parameters and a multivariate partial least square regression (PLSR) machine learning model to correlate easily collected variables, such as the stance time, approaching velocity, and peak accelerations, with knee and ankle loading parameters (moments and contact forces). Results: The key variances of joint loadings were observed from statistical principal component analysis modelling. The promising accuracy of the partial least square regression model using input parameters was observed with a prediction accuracy of 94.52%, while further sensitivity analysis found a single variable from the ankle inertial magnetic unit that could predict an acceptable range (93%) of patterns and magnitudes of the knee and ankle loadings. Conclusion: The attachment of this single inertial magnetic unit sensor could be used to record and predict loading accumulation and distribution, and placement would exhibit less influence on the motions of the lower extremity. The intelligent prediction of loading patterns and accumulation could be integrated to design training and competition schemes in badminton or other court sports in a scientific manner, thus preventing fatigue, reducing loading-accumulation-related injury, and maximizing athletic performance.

Comparison of navigation systems for total knee arthroplasty: A systematic review and meta-analysis

Background

Component alignment is a crucial factor affecting the clinical outcome of total knee arthroplasty (TKA). Accelerometer-based navigation (ABN) systems were developed to improve the accuracy of alignment during surgery. This study aimed to compare differences in component alignment, clinical outcomes, and surgical duration when using conventional instrumentation (CONI), ABN, and computer navigation (CN) systems.

Methods

A comprehensive literature search was carried out using the Web of Science, Embase, PubMed, and Cochrane databases. Articles that met the eligibility criteria were included in the study. Meta-analyses were performed using the Cochrane Collaboration Review Manager based on Cochrane Review Method. The variables used for the analyses were postoperative clinical outcome (PCO), surgical duration, and component alignment, including the hip-knee-ankle (HKA) angle, coronal femoral angle (CFA), coronal tibial angle (CTA), sagittal femoral angle (SFA), sagittal tibial angle (STA), and the outliers for the mentioned angles. The mean difference (MD) was calculated to determine the difference between the surgical techniques for continuous variables and the odds ratio (OR) was used for the dichotomous outcomes.

Results

The meta-analysis of the CONI and ABN system included 18 studies involving 2,070 TKA procedures, while the comparison of the ABN and CN systems included 5 studies involving 478 TKA procedures. The results showed that the ABN system provided more accurate component alignment for HKA, CFA, CTA, and SFA and produced fewer outliers for HKA, CFA, CTA, and STA. However, while the ABN system also required a significantly longer surgical time than the CONI approach, there was no statistical difference in PCO for the two systems. For the ABN and CN systems, there was no statistical difference in all variables except for the ABN system having a significantly shorter surgical duration.

Conclusion

There was no significant difference in the accuracy of component alignment between the ABN and CN systems, but the ABN approach had a shorter surgical duration and at lower cost. The ABN system also significantly improved the accuracy of component alignment when compared to the CONI approach, although the surgery was longer. However, there was no significant difference in PCO between the CONI, ABN, and CN systems.