Fall Prevention after Hip and Knee Arthroplasty

Surgical site soft tissue thickness as a predictor of complications following arthroplasty

Appreciation of soft-tissue thickness (STT) at surgical sites is an increasingly recognized aspect of arthroplasty procedures as it may potentially impacting postoperative outcomes. Recent research has focused on the predictive value of preoperative STT measurements for complications following various forms of arthroplasty, particularly infections, across procedures such as total knee, hip, shoulder, and ankle replacements. Several studies have indicated that increased STT is associated with a higher risk of complications, including infection and wound healing issues. The assessment of STT before surgery could play a crucial role in identifying patients at a higher risk of complications and may be instrumental in guiding preoperative planning to optimize outcomes in arthroplasty procedures. Standardized measurement techniques and further research are essential to enhance the reliability and clinical utility of STT assessment for arthroplasty surgery.

State Healthcare Regulations and Total Knee Arthroplasty Prices Across the United States

Background

The cost of healthcare services in the United States is subject to various regulatory influences, yet the impact of state-level healthcare policies and political affiliations on total knee arthroplasty (TKA) prices remains underexplored.

Methods

Using data from the Turquoise Health Database and publicly available sources, TKA prices were analyzed across states to examine the influence of Medicaid expansion, Certificate of Need (CON) laws, and state partisan lean. Multivariable regression models controlled for Gross Domestic Product per capita, Area Deprivation Index, and urbanization.

Results

Among 64,402 TKAs from 2455 hospitals ($18,164 median, interquartile range: $10,806), states with Medicaid expansion and CON laws demonstrated lower TKA prices. Republican-leaning states had significantly reduced TKA prices compared to Democrat-leaning states, even after adjusting for economic factors (P < .0001).

Conclusions

Medicaid expansion and CON laws were associated with lower TKA prices across the United States. Additionally, states with Republican political leanings tended to have lower listed prices for TKA compared to Democrat-leaning states. These findings underscore the substantial influence of state healthcare policies and political factors on healthcare costs, highlighting the complexities of pricing dynamics in the US healthcare system.

Level of evidence

IV.

Association between work-from-home policies and United States public interest in foot surgery conditions during the COVID-19 pandemic: A Google Trends analysis

BackgroundThe COVID-19 pandemic, marked by significant lifestyle changes and healthcare-seeking behavior shifts, prompted the implementation of widespread Work from Home (WFH) policies.ObjectiveThis study aimed to explore the impact of the COVID-19 pandemic and WFH policies on public interest in foot surgery by using Google Trends searches as a proxy for public interest in the United States.MethodsA comprehensive dataset of foot-related orthopaedic terms was compiled using Google Trends data from March 2018 to March 2022 and captured weekly, representing over 200 observations. The dataset was separated into pre-pandemic and post-pandemic periods. Shaprio-Wilk testing demonstrated nonparametric data, so Mann-Whitney U tests with Cohen's d for effect size were calculated between the two subgroups.ResultsAn analysis of 26 terms showed declines in five and increased interest in four. The largest decrease was noted in "bunion," "foot pain," and "foot fracture." Terms that were newly coined during the pandemic, including "COVID toe" and "COVID feet" were significantly increased. The remaining 17 terms showed nonsignificant fluctuations in search interest.ConclusionThe decline in search interest for foot-related orthopaedic terms during the COVID-19 pandemic may represent the reduced prioritization of nonurgent conditions in the United States. Healthcare professionals should address this through targeted public health initiatives. In a post-pandemic era, healthcare providers should adapt to shifting patient sentiments, public policies, and patient needs.

Wearable health technology finds improvements in daily physical activity levels following total knee arthroplasty: A prospective study

PURPOSE

Wearable technologies, like the Apple Watch, offer new possibilities for collecting objective data on physical activity post-operatively following total knee arthroplasty (TKA). This study aims to describe changes in daily physical activity levels using objective metrics over different time points following TKA.

METHODS

This study analyzed data from a prospective cohort of 152 patients undergoing a unilateral TKA. Patients wore an Apple Watch and used a digital care management application for data collection. Step count, steadiness, standing duration, gait speed and performance on a 6-min walk test were collected from Apple HealthKit at multiple time points: pre-operative, 6 weeks post-operatively, 6 months post-operatively and 12 months post-operatively. Statistical analyses were performed using R software, including descriptive statistics and paired t tests to compare outcomes at different time points post-operatively.

RESULTS

Participants demonstrated significant improvements in daily physical activity levels over the course of 12 months post-operative. At 6 months post-operative, participants showed the highest average daily step count (mean ± SD: 5293 ± 236 steps; p < 0.001), with improvements persisting at 12 months post-operative (5180 ± 260 steps; p < 0.001) compared to preoperative values. Gait speed increased from 0.88 ± 0.01 m/s preoperatively to 1.01 ± 0.01 m/s (p = 0.006) at 12 months post-operative. Standing hours increased from 9.99 ± 0.30 to 11.47 ± 0.31 h at 6 months post-operative and persisted. Steadiness and the estimated 6-minute walk test showed recovery trends, though variability remained at 12 months post-operative, suggesting the need for additional longitudinal assessment CONCLUSION: This study provides one of the first longitudinal analyses of post-operative functional recovery using Apple HealthKit, offering continuous real-world gait and activity tracking beyond traditional patient-reported measures. These findings highlight the value of wearable technology in monitoring post-operative activity and offering insights into TKA recovery patterns. The study suggests a critical recovery window at 6 months post-operative and emphasizes the need for ongoing support to maintain improvements. The integration of wearable technology in post-operative monitoring offers a promising approach to tracking patient progress and optimizing functional outcomes following TKA.

LEVEL OF EVIDENCE

Level II.

How Do Patient-Reported Outcomes Correlate With Real-Time Objective Measures of Function After Total Knee Arthroplasty? A Prospective Study Using Daily Gait Metrics

BACKGROUND

Patient-reported outcomes (PROs) are essential for evaluating patients undergoing total knee arthroplasty (TKA). While wearable technologies offer objective measures of physical function through Apple HealthKit, their relationship with PROs in TKA patients is not well understood. We investigated the association between commonly used PROs and objective measures of physical function in patients undergoing TKA.

METHODS

We conducted a prospective cohort study involving 152 patients undergoing unilateral TKA, assessing PROs (Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, and EuroQol Five-Dimensional Questionnaire) and objective HealthKit metrics (gait speed, step count, standing duration, steadiness, and estimated 6-minute walk test) before and at one, six, and 12 months after surgery. Pearson correlation coefficients were used to analyze the relationship between PROs and HealthKit metrics at each time point, adjusting for multiple comparisons.

RESULTS

Significant improvements were observed in PROs post-TKA. The Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, scores improved from 52.1 ± 11.9 preoperatively to 82.5 ± 13.2 at 12 months postoperatively (P < 0.001), and EuroQol Five-Dimensional Questionnaire scores improved from 73.9 ± 17.8 to 85.7 ± 11.6 over the same period (P < 0.001). However, correlations between PROs and HealthKit metrics were consistently low (mean r = 0.2 to 0.3) and not significant after adjusting for multiple comparisons at various operative time points. Notably, correlations among HealthKit metrics themselves remained high, indicating that objective measures were internally consistent but not strongly related to PROs.

CONCLUSIONS

Despite their importance in patient-centered care, PROs may not fully reflect actual physical function. Clinicians should consider incorporating objective measures, such as those provided by HealthKit, into routine assessments to obtain a more comprehensive view of patient recovery post-TKA.

Daily physical activity following unicompartmental knee arthroplasty: A pilot study

Purpose

The purpose of this study was to understand how objective measures of daily activity change following unicompartmental knee arthroplasty (UKA). Objective data on post-operative changes in daily physical activity following UKA are limited, highlighting the need for studies using wearable technologies to provide real-time assessments of recovery.

Methods

This pilot study included a secondary analysis of a prospective study of 33 consecutive UKA patients, with data collected using an Apple Watch and a digital care management application. Objective metrics, including step count, steadiness, standing duration and performance on the six-minute walk test, were analyzed at different post-operative time points. Descriptive statistics and the Wilcoxon signed-rank test were used for analysis.

Results

Post-operatively, there was a significant increase in daily step count at 6 weeks (p = 0.017), 6 months (p < 0.001) and 12 months (p = 0.0018). Steadiness improved significantly at 6 months (p = 0.049) and 12 months (p = 0.039) post-operatively. Standing duration increased significantly at all the post-operative time points (p < 0.001). Gait speed did not show significant changes post-operatively. The estimated six-minute walk test distance improved significantly at 6 months (p = 0.027) and 12 months (p = 0.031) post-operatively.

Conclusion

The study findings suggest that UKA improves daily physical activity levels, reflected by enhanced mobility and function. While gait speed did not significantly change, improvements in step count, steadiness, standing duration and the six-minute walk test distance indicate enhanced functional capacity and endurance post-operatively. The study highlights the benefits of UKA in improving functional outcomes in patients with knee osteoarthritis. Further research with larger sample sizes and longer follow-ups is warranted to confirm these findings.

Levels of Evidence

II.

Clinic of Hope: bridging infectious disease and orthopaedic surgery in prosthetic joint infection management

Prosthetic joint infections (PJIs) following total joint arthroplasty are a significant and costly complication. To address fragmented care typically seen with separate management, we established a combined infectious disease and orthopaedic surgery clinic at Duke Health in July 2020. This clinic focuses on patients experiencing acute deterioration or multiple PJI episodes, often at the stage where amputation is the only option offered. From July 2021 to March 2024, the clinic completed 974 visits with 319 unique patients. The clinic maintained a low no-show rate of 5.0%. Treatment plans included procedures such as debridement, antibiotics and implant retention (38%), as well as implant explantation and one-stage exchange (32% each), with amputation required in only 4% of cases. The integrated clinic model facilitated real-time, multidisciplinary care, improving patient outcomes and operational efficiency. This approach offers a promising model for managing complex infections.