The Role of Wearable Technology in Measuring and Supporting Patient Outcomes Following Total Joint Replacement: Review of the Literature

Recovery of Ambulation After Staged Bilateral Total Knee Arthroplasty Is Not Affected by Timing of Second Side Surgery: A Retrospective Analysis of Implanted Sensor Data

BACKGROUND

Bilateral knee osteoarthritis is often treated with staged bilateral total knee arthroplasty (BTKA). However, the optimal surgical timing for staging remains contended. In this study, a smart implant sensor was used to assess the association between surgical timing of stages and recovery of ambulation after the second total knee arthroplasty (TKA).

METHODS

Overall, 246 staged bilateral and 2,209 unilateral TKA patients received a sensor-enabled knee implant between 2021 and 2023. Staged BTKA patients were stratified into three subgroups based on time intervals between surgeries: extra early (< 6 weeks), early (< 13 weeks), or standard (≥ 13 weeks). Mixed effects repeated measures modeling methods were used to compare daily qualified step count, walk speed, and functional knee range of motion (ROM) during ambulation between the groups.

RESULTS

The three BTKA groups had significantly different daily step counts, walking speed, and knee ROM during the preoperative period before the second TKA. The extra early bilateral group took fewer qualified steps (P < 0.05), walked slower (P < 0.05), and had less knee ROM (P < 0.05) than both the early and standard groups at the 2-week point before their second TKA (P < 0.0 5). At 26 weeks after the second TKA, walking speed, and knee ROM showed no significant difference across the extra early, early, standard, and unilateral groups (P > 0.05).

CONCLUSIONS

Close staging of BTKA surgeries, even less than 6 weeks apart, did not negatively affect the recovery of postoperative ambulation after the second TKA. Our results may help inform surgeons and patients on timing for staging, especially if a shorter staging is preferred for convenience and shorter overall recovery time.

LEVEL OF EVIDENCE

III Retrospective Cohort Study.

Continuous vital sign monitoring with Biobeat® wearable devices for post-ambulatory surgery patients: a pilot feasibility study

Improvement in anesthesia and surgical practices has enabled more patients, including those undergoing higher-risk surgeries, to be treated in outpatient settings. This shift creates a need for reliable postoperative monitoring at home. Wearable devices like the Biobeat® offer continuous, real-time monitoring of vital signs have remained largely untested for home use in this context.A prospective, single-center observational study was conducted at the Centre hospitalier de l'Université de Montréal (CHUM) from February to August 2023. Fifty eligible patients underwent continuous monitoring with the Biobeat® device for five days post-surgery, with data transmitted to CHUM's telehealth service. Feasibility was assessed by the percentage of patients without data loss during consecutive 2-hour intervals.Of the 50 patients enrolled, 49 completed the study, but all experienced some level of data loss. While 39.6% of patients maintained connectivity without complete data loss for 6-8-hour intervals, challenges included device discomfort, Bluetooth disconnection, and connectivity issues. Thirteen patients removed the device early due to discomfort or technical issues. Of the 3 patients who experienced post-operative complications, no data was available within 24 h prior to the episodes. Continuous vital signs monitoring is feasible for high-risk outpatient surgery patients; however, significant improvements are required in device reliability and data accessibility. Further studies are needed to refine the technology and develop reliable protocols for postoperative monitoring in the home setting.

The future outlook for data in orthopedic surgery: A new era of real-time innovation

The orthopedic field is on the brink of a significant transformation-a shift from retrospective analysis to real-time decision-making fueled by data. The dependence on historical trends or long-term studies is yielding to an era where data flows dynamically, allowing medical professionals to adjust protocols instantly. This isn't just an evolution; it's a revolution. Data is no longer a passive observer of outcomes-it's an active participant in shaping them.Imagine a future where wearable devices, artificial intelligence (AI) algorithms, and predictive analytics come together to guide surgeons in real time. For example, wearables monitor vital signs during surgery and oversee rehabilitation while AI analyzes data to predict complications. Postoperative protocols adapt to individual recovery journeys, not averages. Complication risks are flagged preemptively, and treatment plans evolve with patient progress. This shift empowers orthopedic professionals to respond and anticipate, creating a level of care precision that was once unimaginable.What if we viewed data not merely as a tool but as collaborators? With AI and machine learning, the surgical suite of tomorrow transforms into ecosystems where data communicates directly providing insights, suggesting strategies, and enhancing outcomes. This collaborative approach encourages our conventional medical mindset to prioritize adaptability and individualization.The provocative truth is that the game-changer in orthopedics isn't a new implant design or surgical technique-it's the mindset shift to trust real-time data as the foundation of every decision. Orthopedics is no longer about perfecting procedures but refining protocols for every patient consistently.As we race toward the future, equitable access becomes crucial. As William Gibson noted, "The future is already here - it's just not very evenly distributed." We must ensure these breakthroughs reach everyone, bridging the gap between potential and practice. The future of orthopedics isn't just a vision - it's a promise, and it's time to deliver.

Stepping up recovery: integrating patient reported outcome measures and wearable technology for 90-day rehabilitation following total hip arthroplasty

INTRODUCTION

There is conflicting data in the literature regarding the clinical utility of wearable devices. This study examined the association between patient reported outcome measures (PROMs) and step and stair flight counts obtained from wearable devices in postoperative total hip arthroplasty (THA) patients.

METHODS

Data was collected from a multicenter prospective longitudinal cohort study from October 2018 to February 2022. A smartphone-based platform with smartwatch was utilized for collection of daily step and stair flight counts. Subjects (N = 1644) completed the Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) and numerical rating scale (NRS) pain scores preoperatively and at 1 and 3 months postoperatively. Patients who reported living in a multi-level home (N = 931) were included in analysis of stair flight counts. Pearson correlation coefficients were calculated to determine correlations between step and stair flight counts with NRS pain and HOOS JR scores.

RESULTS

Step counts demonstrated a weak negative correlation to NRS pain scores at preoperative (r = - 0.15, p < 0.0001), 1-month (r = - 0.15, p < 0.0001), and 3-months follow-up (r = - 0.06, p = 0.05). Step counts demonstrated a weak positive correlation with HOOS JR scores at preoperative (r = 0.16, p < 0.0001), 1-month (r = 0.15, p < 0.0001), and 3-months (r = 0.13, p < 0.0001). Stair flight counts demonstrated a weak negative correlation with NRS pain preoperatively (r = - 0.19, p < 0.0001) and at 1-month (r = - 0.11, p = 0.003). Stair flight counts positively correlated with HOOS JR scores at preoperative (r = 0.24, p < 0.0001), 1-month (r = 0.15, p < 0.0001), and 3-months (r = 0.09, p = 0.02).

CONCLUSION

The utilization of wearable technology can enhance the evaluation of patient outcomes after THA, primarily due to the observed correlation between data collected from wearables and PROMs. Our study highlights the importance of the use of objective data, in addition to subjective patient reported data, when analyzing postoperative patient progress, which propels forward the field of postoperative THA patient care.

Feasibility of continuous physical activity monitoring: first-month recovery markers following joint replacement surgery

Background

The role of physical activity (PA) monitoring during the recovery after orthopaedic surgeries is unclear. This study aimed to explore early changes in the pattern and level of PA following orthopedic surgeries.

Methods

This observational feasibility study included 11 hip replacement patients (four females) with a mean age of 66 years and five knee replacement patients (four females) with a mean age of 65 years. A PA tracker was used to collect the patients' daily PA data, including duration of various activity categories, steps taken, and activity intensity count. The PA tracker recorded data from two weeks prior to surgery until four weeks after the surgery. Ratios of PA parameters for each of the first four weeks following surgery were calculated in relation to preoperative measurements.

Results

Compared to preoperative measurements, during the first four weeks after the surgery, the time spent in a recumbent position decreased from 112% to 106%, while continuous walking time and activity intensity count increased from 27% to 77% and from 35% to 73%, respectively. Step counts increased from 18% to 67%, and sit-to-stands rose from 65% to 93%. No significant changes were found in sitting, standing, sporadic walk time, and sporadic steps.

Conclusion

Continuously measuring PA using wearable sensors was feasible in orthopedic patients during the perioperative period. Continuous step count, walking time, activity intensity count showed noticeable changes and stable patterns demonstrating their potential for remote monitoring of patients during the early postoperative period.

An Interactive Vision-Based 3D Augmented Reality System for In-Home Physical Rehabilitation: A Qualitative Inquiry to Inform System Development

BACKGROUND

Postoperative physical rehabilitation is crucial after total joint replacement (TJR). However, completing the recommended levels of postoperative physical exercise is challenging for many older adults with TJR. Lack of adequate postoperative physical exercise has negative consequences on rehabilitation outcomes. Innovative rehabilitation tools for postoperative physical exercises are needed to ensure successful rehabilitation outcomes among older adults with TJR.

OBJECTIVE

The aim of this study is to explore key knowledge users' perspectives about how to design an interactive vision-based three-dimensional augmented reality system (3D ARS) to support in-home postoperative physical rehabilitation for older adults with TJR.

METHODS

We conducted a qualitative descriptive study involving 11 semi-structured interviews and six focus groups with 42 older adults with TJR and four unrelated family caregivers. Data were analysed using thematic analysis.

RESULTS

Participant insights were grouped into two main themes: (1) dreaming up possibilities and (2) being pragmatic. The first theme captured participants' reflections on the potential utility of a 3D ARS for postoperative physical rehabilitation and features that could be embedded in the 3D ARS to support successful postoperative physical rehabilitation. The second theme captured participants' reflections on practical issues and considerations that could impact access and usage of the 3D ARS.

CONCLUSION

These findings provide researchers, rehabilitation providers and system developers with the foundations for designing, implementing and evaluating innovative augmented reality tools that support effective in-home physical rehabilitation among older adults with TJR.

PATIENT OR PUBLIC CONTRIBUTION

Research users (i.e., individuals and organisations invested in and using the research findings) were actively engaged throughout this work. Specifically, a meeting was held between the research team and representatives of an Expert by Experience team (individuals with lived experience), which was established to support the National Research Council's (organisation) Aging in Place programme. During this meeting, the idea to develop and evaluate an ARS for postoperative physical rehabilitation of older adults with TJR was supported. Research users had the opportunity to review the current study protocol and provide feedback on the study design, offering direction to maximize the relevance and usefulness of our findings to the National Research Council Canada's Aging in Place programme. Research users contributed to participant recruitment efforts and the development of the interview guide. Two Experts by Experience also agreed to be on the Advisory Panel for this multi-phased study, supporting active engagement and centring the voice of research users in knowledge creation and implementation. These experts reviewed a brief report of the current study findings, and continue to guide how the study findings are used to inform the next phase of this multi-phased research.

Stepping Up Recovery: Integrating Patient-reported Outcome Measures and Wearable Technology for Rehabilitation Following Knee Arthroplasty

Improvement after knee arthroplasty (KA) is often measured using patient-reported outcome measures (PROMs). However, PROMs are limited due to their subjectivity. Therefore, wearable technology is becoming commonly utilized to objectively assess physical activity and function. We assessed the correlation between PROMs and step/stair flight counts in total (TKA) and partial knee arthroplasty (PKA) patients.Analysis of a multicenter, prospective, longitudinal cohort study investigating the collection of average daily step and stair flight counts, was performed. Subjects (N = 1,844 TKA patients and N = 489 PKA patients) completed the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) and provided numerical rating scale pain scores pre- and postoperatively. Only patients who reported living in a multilevel home environment (N = 896 TKA patients and N = 258 PKA patients) were included in analysis of stair flight counts. Pearson correlation coefficients were calculated to determine correlations between variables.Among TKA patients, pain scores demonstrated a negative correlation to mean step counts at preoperative (r = -0.14, p < 0.0001) and 1-month follow-up (r = -0.14, p < 0.0001). Similar negative correlations were true for pain and stair flight counts at preoperative (r = -0.16, p < 0.0001) and 1-month follow-up (r = -0.11, p = 0.006). KOOS JR scores demonstrated weak positive correlations with mean step counts at preoperative (r = 0.19, p < 0.0001) and 1-month postoperative (r = 0.17, p < 0.0001). Similar positive correlations were true for KOOS JR scores and stair flight counts preoperatively (r = 0.13, p = 0.0002) and at 1-month postoperatively (r = 0.10, p = 0.0048). For PKA patients, correlations between pain and KOOS JR with step/stair counts demonstrated similar directionality.Given the correlation between wearable-generated data and PROMs, wearable technology may be beneficial in evaluating patient outcomes following KA. By combining subjective feedback with the objective data, health care providers can gain a holistic view of patients' progress and tailor treatment plans accordingly.

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.

System for Tracking and Evaluating Performance (Step-App®): validation and clinical application of a mobile telemonitoring system in patients with knee and hip total arthroplasty. A prospective cohort study

BACKGROUND

Technological advances and digital solutions have been proposed to overcome barriers to sustainable rehabilitation programs in patients with musculoskeletal disorders. However, to date, standardized telemonitoring systems able to precisely assess physical performance and functioning are still lacking.

AIM

To validate a new mobile telemonitoring system, named System for Tracking and Evaluating Performance (Step-App®), to evaluate physical performance in patients undergone knee and hip total arthroplasty.

DESIGN

Prospective cohort study.

METHODS

A consecutive series of older adults with knee and hip total arthroplasty participated in a comprehensive rehabilitation program. The Step-App®, a mobile telemonitoring system, was used to remotely monitor the effects of rehabilitation, and the outcomes were assessed before (T0) and after the rehabilitation treatment (T1). The primary outcomes were the 6-Minute Walk Test (6MWT), the 10-Meter Walk Test (10MWT), and the 30-Second Sit-To-Stand Test (30SST).

RESULTS

Out of 42 patients assessed, 25 older patients were included in the present study. The correlation analysis between the Step-App® measurements and the traditional in-person assessments demonstrated a strong positive correlation for the 6MWT (T0: r2=0.9981, P<0.0001; T1: r2=0.9981, P<0.0001), 10MWT (T0: r2=0.9423, P<0.0001; T1: r2=0.8634, P<0.0001), and 30SST (T0: r2=1, P<0.0001; T1: r2=1, P<0.0001). The agreement analysis, using Bland-Altman plots, showed a good agreement between the Step-App® measurements and the in-person assessments.

CONCLUSIONS

Therefore, we might conclude that Step-App® could be considered as a validated mobile telemonitoring system for remote assessment that might have a role in telemonitoring personalized rehabilitation programs for knee and hip replacement patients.

CLINICAL REHABILITATION IMPACT

Our findings might guide clinicians in remote monitoring of physical performance in patients with musculoskeletal conditions, providing new insight into tailored telerehabilitation programs.