Introduction. Provision of prehabilitation prior to total knee arthroplasty (TKA) through a digital mobile application is a novel concept. The primary aim of our research is to determine whether provision of prehabilitation through a mobile digital application impacts length of stay (LOS), requirement for inpatient rehabilitation and hospital-associated costs after TKA. Our study hypothesis is that a mobile digital application provides a low resource, cost effective method of delivering prehabilitation prior to TKA. Methods. An observational, retrospective analysis was performed on a consecutive case series of 64 patients who underwent TKA by a single surgeon over a 21-month period. Pre operative Knee Osteoarthritis Outcome Score (KOOS) Patient Reported Outcome Measures (PROMs) were collected on all patients. The first group of patients (control) did not undergo prehabilitation, the subsequent group of patients (experimental) were offered prehabilitation through a mobile application called PhysiTrack. The experimental group were provided with progressive quadriceps and hamstring strengthening exercises, and calf and hamstring stretches. Exercises were automatically progressed after 2 weeks unless the patient requested otherwise or a physiotherapist clinically intervened. The non-compliance rate was 33% (n=11), after removing these patients from the analysis, 22 patients remained and these were age matched to 22 patients from the control group. Aside from the access to prehabilitation, all patients underwent TKA using identical surgical technique and peri-operative care regime. Length of stay data for inpatient care and rehabilitation were captured for all patients. Cost was calculated using the inpatient and rehabilitation costs provided by the hospital. Results. 44 patients were included in our final analysis. Pre operative KOOS were collected for all of the experimental group and 18 (81%) of control group. These subscores were not statistically different (p>0.05) reflecting pre operative equivalence. The average inpatient length of stay was statistically different, being 5.04 days for the control group and 4.31 days for the experimental group (p=0.01). The decision for ongoing inpatient rehabilitation (after the immediate post-operative inpatient period) was not statistically different between the groups (chi-quared p=0.07). Rehabilitation length of stay was 9.12 days in the experimental and 10.85 days in the control group (p = 0.25). The remaining outcomes were statistically significant with total length of stay 11.95 days in the control and 7.63 days in the experimental group (p=0.01) and the total cost of the hospital stay $6362.55AUD for the control and $4145.17AUD for the experimental group (p=0.01). This represents an average saving $2217.38 per patient who participated in prehabiliation prior to surgery. Conclusions. Our research shows a significant cost saving with this intervention, as measured by reduction in total length of stay in patients undergoing prehabilitation using PhysiTrack. To our knowledge, this is the first study that analyses the impact of a mobile application providing prehabilitation prior to TKA. Further work is required to determine the effect in a larger, randomised cohort of patients. Future studies should also be directed towards assessing the utility of digital prehabilitation on a per patient basis prior to total knee arthroplasty

Provision of prehabilitation prior to total knee arthroplasty (TKA) through a digital mobile application is a novel concept. Our research evaluates a resource effective and cost effective method of delivering prehabilitation. The primary aim of our research is to determine whether provision of prehabilitation through a mobile digital application impacts inpatient LOS after TKA. The secondary objective is to understand the effect of digital prehabilitation on hospital costs. An observational, retrospective analysis was performed on a consecutive case series of 64 patients who underwent TKA by a single surgeon over a 21 month period. Exercise provision varied from 3 months to 2 weeks prior to TKA. The outcomes of rehabilitation length of stay, total length of stay and total hospital costs were statistically significantly at p=0.5. The rehabilitation length of stay was 3.79 days in the experimental and 7.33 days in the control group (p = 0.045), the total length of stay was 12.00 days in the control and 8.04 days in the experimental group (p=0.03) and the total cost of the hospital stay was $6357.35AUD for the control and $4343.22AUD for the experimental group (p=0.029). Our research shows a cost saving with this intervention, as measured by a reduction in rehabilitation length of stay. To our knowledge, this is the first piece of research that analyses the impact of the use of a digital mobile application providing prehabilitation prior to TKA

Introduction. With advances in mobile application, digital health is being increasingly used for remote and personalised care. Patient education, self-management and tele communication is a crucial factor in optimising outcomes. Aims. We explore the use of a smartphone app based orthopaedic care management system to deliver personalised surgical experience, monitor patient engagement and functional outcomes of patients undergoing knee arthroplasty. Results. Over a 12-month period, 124 patients listed for knee arthroplasty were offered access to the app. Average patient age was 65.4 years (range 49 to 86). 13(10.4%) patients were over 80 years. Compliance with app usage was 86.4%. Compliance with post-operative exercises increased following a message through the app. The mean Oxford knee score improved from a pre-op value of 17 to 35 at a mean follow-up of 6 months. Mean numeric rating scale pain score reduced from 7 pre-operatively to 3 at the latest follow-up. 58 patients (46.7%) used the communication feature on the app (text messages, photos, video consultations), reducing telephone calls and patient foot fall in the hospital. Patient satisfaction with the app was very high. Conclusion. We found the virtual care system to be effective in providing patient education, prehabilitation and post-operative rehabilitation along with being an effective channel of communication between patients and the hospital team. Patient satisfaction and compliance was very high

Aims

Elective orthopaedic services have had to adapt to significant system-wide pressures since the emergence of COVID-19 in December 2019. Length of stay is often recognized as a key marker of quality of care in patients undergoing arthroplasty. Expeditious discharge is key in establishing early rehabilitation and in reducing infection risk, both procedure-related and from COVID-19. The primary aim was to determine the effects of the COVID-19 pandemic length of stay following hip and knee arthroplasty at a high-volume, elective orthopaedic centre.