Total Knee Arthroplasty (TKA) has been demonstrated to drastically improve a patient's quality of life. The outcomes following TKA are often reported by subjective patient reported outcome measurements (PROMs). However, there are few objective outcome measures following TKA, limiting the amount of information physicians can use to effectively guide a patient's recovery, especially in the first 3 weeks. Newly developed knee sensors have been able to ameliorate this problem by providing the physician with previously unobtainable objective data. Our study aims to evaluate the use of a wearable knee sensor device to measure functional outcomes (range of motion and steps) in real time. 29 patients who underwent primary, unilateral TKA were recruited for this IRB approved study. Patients were instructed how to use the device and associated mobile phone application preoperatively (Figure 1) and provided knee sensors to wear postoperatively (Figure 2). Patients wore the device for 3 weeks postoperatively to allow for data collection. The device recorded range of motion, number of steps, and percentage of physical therapy exercises completed. Patients were grouped by gender, age (<69 or >=70 years old), and BMI (<30 and >=30 kg/m2) for analysis of functional outcome measurements (maximum flexion, minimum extension, and number of steps). Unpaired two-sample t-tests were used to analyze differences between the groups.Introduction
Methods
Total Knee Arthroplasty (TKA) provides patients with significant improvements in quality of life. Subjective patient reported outcome measures (PROMs) are traditionally used to measure preoperative functional status and postoperative outcomes. However, there are limitations to PROMs. In particular, they provide virtually no functional information in the first 3 weeks after surgery, which could be used to guide the patient's recovery. Newly available wearable electronic sensors make it possible to: 1) measure important functional outcomes following TKA; 2) guide the patient's physical therapy (PT); and 3) provide real-time functional and clinical information to the provider. Compliance with PT after TKA is a challenge. Patients cite time, transportation, and cost as deterrents to PT appointments. However, an intensive PT program is essential in TKA. Surface sensor devices may be able to increase PT compliance by guiding patients through exercises at home. Additionally, these devices can transmit PT progress in real-time to the providers, allowing them to monitor and assist the patient's recovery. Our study investigates the feasibility of using a surface sensor device (TracPatch™) on patients following TKA. We sought to answer the following questions: 1) Will patients tolerate the device; 2) Will patients comply with device instructions; 3) Will patients be able to use the smart phone application; 4) Will the device collect, transmit, and store data as it was designed? We believe these fundamental questions must be answered as we enter the era of personal sensor-measured functional outcomes. 20 patients undergoing primary, unilateral TKA were enrolled in this IRB approved study. At the pre-surgical visit, patients were given instructions for the device and smart phone application. Each patient used the device in the week prior to surgery, and data was collected. The device was again applied in the operating room. For 3 weeks post-operatively, the device collected functional data, along with WOMAC, OKS, KSS, PROMIS, and VAS pain scores. A satisfaction survey was collected on the device.Background
Methods
Supine positioning during direct anterior approach total hip arthroplasty (DAA THA) facilitates use of fluoroscopy, which has been shown to improve acetabular component positioning on plane radiograph. This study aims to compare 2- dimensional intraoperative radiographic measurements of acetabular component position with RadLink to postoperative 3- dimensional SterEOS measurements. Intraoperative fluoroscopy and RadLink (El Segundo, CA) were used to measure acetabular cup position intraoperatively in 48 patients undergoing DAA THA. Cup position was measured on 6-week postoperative standing EOS images using 3D SterEOS software and compared to RadLink findings using Student's t-test. Safe-zone outliers were identified. We evaluated for measurement difference of > +/− 5 degrees.Background
Methods
Total hip arthroplasty (THA) is a highly successful procedure, yet access to arthroplasty is limited in many developing nations. In response, organizations around the world have conducted service trips to provide international arthroplasty care to underserved populations. Little outcomes data are currently available related to these trips. We present a 1-year follow up. We completed an arthroplasty service trip to Brazil in 2017 where we performed 46 THAs on 38 patients. Patient demographic data, comorbidity profile, complication data, and pre- and postoperative Modified Harris Hip Score (mHHS), PROMIS Short Form Pain (SF-Pain), PROMIS Short Form Physical Function (SF-Function), and HOOS Jr scores were collected. Outcomes were collected postoperatively at 2, 6, and 12 weeks and 1 year. A multivariate regression analysis was performed to identify associations between patient factors and 12-week outcomes.Background
Methods
Direct anterior approach (DAA) total hip arthroplasty (THA) has been reported to improve early outcomes as compared to posterior approach THA up to 6 weeks post-operatively. However, very few detailed results have been reported within the first 6 weeks. In this study we investigate the effect of surgical approach on THA outcome via weekly assessment. Patients undergoing THA for primary osteoarthritis were prospectively enrolled. Data was collected pre-operatively and post-operatively at weekly intervals for 6 weeks. Outcome scores and additional functional measures were compared using unpaired t-test, effect size, and Pearson correlation coefficients.Introduction
Methods
Total hip replacement is a highly successful procedure, yet access to arthroplasty is limited in many developing nations. In response, organizations in the United States have conducted service trips to provide international arthroplasty care to underserved populations. Little outcomes data are currently available related to these trips. We aimed to assess patient outcomes following total hip arthroplasty performed on a surgical mission trip. We completed an arthroplasty service trip to Brazil during which we performed 46 total hip arthroplasties (THA) on 38 patients. Patient demographic data, comorbidity profile, complication data, and pre- and postoperative Modified Harris Hip Score (mHHS), PROMIS Short Form Pain (SF-Pain), PROMIS Short Form Physical Function (SF-Function), and HOOS Jr scores were collected. Baseline and final follow-up scores were compared. In addition, we utilized a novel questionnaire that was designed to determine outcomes most relevant to patients receiving joint replacements in developing countries. A multivariate regression analysis was performed to identify associations between patient factors and outcomes.Background
Methods
Predicting length of stay (LOS) is key to providing a cost effective and efficient arthroplasty service in an era of increasing financial constraint. Previous studies predicting LOS have not considered enhanced recovery protocols in elective hip and knee arthroplasty. Our study aims to identify patient variables in the pre and peri-operative period to predict increased LOS on patients enrolled into the standardised Chichester and Worthing Enhanced Recovery Programme (CWERP). All patients undergoing elective hip and knee arthroplasty were enrolled into CWERP using standardised anaesthetic, surgical and analgesic protocols. A data analyst prospectively collated data over 6months from anaesthetic charts and daily ward review from 663 patients between Dec 2012 and June 2013. An independent statistician undertook statistical analysis (program R, version 3.1.1). 80% of the 6months consecutive data (530 patients) were analysed, and predictive variables identified. These variables were tested against the remaining 20% of data (133 patients) predicting a LOS greater or less than our median of 4 days.Background
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