Aims. The purpose is to determine the non-inferiority of a smartphone-based exercise educational care management system after primary knee arthroplasty compared with a traditional in-person physiotherapy rehabilitation model. Methods. A multicentre prospective randomized controlled trial was conducted evaluating the use of a smartphone-based care management system for primary total knee arthroplasty (TKA) and partial knee arthroplasty (PKA). Patients in the control group (n = 244) received the respective institution’s standard of care with formal physiotherapy. The treatment group (n = 208) were provided a smartwatch and smartphone application. Early outcomes assessed included 90-day knee range of movement, EuroQoL five-dimension five-level score, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) score, 30-day single leg stance (SLS) time, Time up and Go (TUG) time, and need for manipulation under anaesthesia (MUA). Results. Overall, 90-day mean flexion was not significantly different between the control (121° (SD 11.7°)) and treatment groups (121. o. ; p = 0.559); 90-day mean SLS was 22.7 seconds (SD 9.8) in controls and 24.3 seconds (SD 20.8) in treatment (p = 0.519); 90-day mean TUG times were 10.1 seconds (SD 4.8) in control and 9.3 seconds (SD 3.3) in treatment (p = 0.139). Mean KOOS JR scores were significantly different between control group (73.6 (SD 13.4)) and treatment group (70.4 (SD 12.6); p = 0.026). MUAs were performed in nine (3.7%) patients in the control group and four (1.9%) in the treatment group (p = 0.398). Physiotherapy was performed by 230 (94.4%) of control group and 123 (59.3%) of treatment group (p < 0.001). There were no significant differences between groups in postoperative urgent care visits, or readmissions within 90 days, with significantly fewer emergency department visits in the treatment group (16 (8.2%) vs five (2.5%), p = 0.014). Conclusion. The use of the smartwatch/smartphone care platform demonstrated non-inferiority of clinically significant outcomes to traditional care models, while requiring significantly less postoperative physiotherapy and fewer emergency department visits. This platform could aid in decreasing postoperative costs, while improving patient engagement and communication with the healthcare team. Cite this article: Bone Joint J 2021;103-B(6 Supple A):3–12

Abstract. Patient Reported Outcome Measures (PROMs) can be completed using paper and postal services (pPROMS) or via computer, tablet or smartphone (ePROMs). We have investigated whether there are differences in scores depending on the method of PROMs acquisition for the Oxford Knee (OKS) and the EQ-5D scores, at one and two years post operatively. Patient demographics, mode of preferred data collection and pre-and post-operative PROMs for Total Knee Replacements (TKRs) performed between 1st January 2018 and 31st December 2018 were collected. During the study period, 1573 patients underwent TKRs. The average OHS and EQ-5D pre-operatively scores was 19.47 and 0.40 respectively. 71.46% opted to undertake post-operative questionnaires using ePROMs. The remaining 28.54% opted for pPROMS. The one and two-year OHS for ePROMS patients increased to 37.64 and 39.76 while the OHS scores for pPROMS patients were 35.71 and 36.83. At the one and two-year post-operative time intervals, a Mann-Whitney test showed statistical significance between the modes of administration for OHS (P-Value = 0.044 and 0.01 respectively). The one and two-year EQ-5D for ePROMS patients increased to 0.76 and 0.78 while the EQ-5D scores for pPROMS patients were 0.73 and 0.76. The P-Value for Mann-Whitney tests comparing the modes of administration for EQ-5D were 0.04 and 0.07 respectively. There is no agreed mode of PROMs data acquisition for the OKS and EQ-5D Scores. While we have demonstrated an apparent difference in scores depending on the mode of administration, further work is required to establish the influence of potentially confounding factors

Background. The purpose of this study is to evaluate the early perioperative outcomes after primary knee arthroplasty with the use of a smartphone-based exercise and educational platform compared to a standard of care control group. Methods. A multicenter prospective randomized control trial was conducted evaluating the use of the mymobility smartphone-based care platform for primary total knee arthroplasty (TKA) and unicondylar knee arthroplasty (UKA). Patients in the control group (224 patients) received the respective institution's standard of care typically with formal physical therapy. Those randomized to mymobility treatment group (192 patients) were provided an Apple Watch and mymobility smartphone application. The treatment group was not initially prescribed physical therapy, but could if their surgeon determined it necessary. Early outcomes assessed included 90-day knee range of motion, KOOS Jr scores, 30-day single leg stance (SLS) time, Time up and Go (TUG) time and need for manipulation under anesthesia (MUA). There was no significant difference in age, BMI or gender between groups. Results. The 90-day knee flexion was not significantly different between controls (118.3±11.8) and mymobility (118.8 ±12) (p=0.7), nor was knee extension (1.6 ±3.5 vs. 1 ±3.1, p=0.16). KOOS Jr scores were not significantly different between control group (74 ±13.1) and mymobility group (71 ±13.3) (p=0.06). 30-day SLS was 22.3 ± 19.5 sec in controls and 24 ± 20.8 sec in mymobility (p=0.2). 30-day TUG times were 16 ± 44.3 sec in control and 15 ± 40.6 sec in mymobility (p=0.84). MUAs were performed in 4.02% of patients in the control group and 2.8% in the mymobility group (p=0.4%). Conclusion. The use of the mymobility care platform demonstrated similar early outcomes to traditional care models, while providing communication and insights into patient engagement with the care plan. There was no significant difference in 90-day range of motion or need for MUA

Introduction. A smartphone-based care platform allows a customizable educational and exercise interface with patients, allowing many to recover after surgery without the need for formal physical therapy (PT). Furthermore, advances in wearable technology to monitor physical activity (PA) provides patients and physicians quantifiable metrics of the patient's recovery. The purpose of this study is to determine the feasibility of a smartphone-based exercise educational platform after primary knee arthroplasty as well as identifying factors that may predict the need for formal physical therapy. Methods. This study is part of a multi-institution, prospective study of patients after primary total knee arthroplasty (TKA) and partial knee arthroplasty (PKA) enrolled in a smartphone with smartwatch-based episode of care platform that recorded multimodal PA (steps, kcal, stairs). Postoperatively, all patients initially followed the smartphone-based exercise program. At the surgeon's discretion, patients were prescribed therapy if needed. The outcome of this study was the need for PT outside the app-based exercise program as well as time to return to preoperative step count. Variables assessed were preoperative weekly step counts (steps/day), weekly postoperative activity level (weekly step count compared to preoperative level), compliance with the exercise program (>75% completion) and patient demographic data including gender, age, BMI and narcotic use. One hundred eighty-eight patients were included in analysis: 45 PKA (24%) and 143 TKA (76%). Step count data was available on 135 patients and physical therapy data on 174. Results. Overall educational compliance was 91% and exercise compliance 34%. By 4-weeks postop, 45.6% of patients reached or exceeded their preoperative step count, including 60% of PKA and 41% of TKA (p=0.05). There was no significant difference in reaching step count based on gender (p=0.7), BMI <40kg/m2 (p=0.9) or age <65-years old (p=0.67). Sixty-three percent of patients that were compliant with the exercise program reached the step count compared to 40% of patients that weren't complaint (p=0.01). One hundred thirty-three patients (76.4%) completed the app-based exercise program without the need for PT, which included 81.4% of PKA patients and 75% of TKA patients (p=0.38). Weekly compliance with the exercise program (>75%) was significantly associated with not needing PT (p<0.001). Other factors that were significantly associated with the need for PT were a high physical activity level in postoperative week 1 (p<0.001) and a low physical activity level in postoperative week 2 (p=0.002). Conclusion. A high percentage of patients after primary knee arthroplasty were able to successfully complete the smartphone-based exercise program without the need for PT. Compliance with the exercise program was an important predictor of success. Postoperative activity level may also indicate the need for therapy as patients who were very active in the first postoperative week and then saw a decline in activity in the second week were more likely to be prescribed PT. With this platform, surgeons can monitor a patient's exercise compliance and postoperative activity level allowing many to recover at home, while being able to identify those within the first few weeks who may need structured physical therapy. For figures, tables, or references, please contact authors directly

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The COVID-19 pandemic led to a swift adoption of telehealth in orthopaedic surgery. This study aimed to analyze the satisfaction of patients and surgeons with the rapid expansion of telehealth at this time within the division of adult reconstructive surgery at a major urban academic tertiary hospital.

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This study aims to evaluate a new home medical stretching device called the Self Treatment Assisted Knee (STAK) tool to treat knee arthrofibrosis.

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The purpose of this study was to develop a personalized outcome prediction tool, to be used with knee arthroplasty patients, that predicts outcomes (lengths of stay (LOS), 90 day readmission, and one-year patient-reported outcome measures (PROMs) on an individual basis and allows for dynamic modifiable risk factors.

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The aims of this study were to determine the proportion of patients with outlier varus or valgus alignment in kinematically aligned total knee arthroplasty (TKA), whether those with outlier varus or valgus alignment have higher forces in the medial or lateral compartments of the knee than those with in-range alignment and whether measurements of the alignment of the limb, knee and components predict compartment forces.

The routine use of patient reported outcome measures (PROMs) in evaluating the outcome after arthroplasty by healthcare organisations reflects a growing recognition of the importance of patients’ perspectives in improving treatment. Although widely embraced in the NHS, there are concerns that PROMs are being used beyond their means due to a poor understanding of their limitations.

This paper reviews some of the current challenges in using PROMs to evaluate total knee arthroplasty. It highlights alternative methods that have been used to improve the assessment of outcome.

Cite this article: Bone Joint J 2015;97-B:3–9.