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Monitoring Patient Recovery After THA or TKA Using Mobile Technology

Abstract

Background

Smartphones offer the possibility of assessing recovery of mobility after total hip or knee arthroplasty (THA or TKA) passively and reliably, as well as facilitating the collection of patient-reported outcome measures (PROMs) with greater frequency.

Questions/Purposes

We investigated the feasibility of using mobile technology to collect daily step data and biweekly PROMs to track recovery after total joint arthroplasty.

Methods

Pre- and post-operative daily steps were recorded in prospectively enrolled patients (128 THA and 139 TKA) via an app, which uses the phone’s accelerometer. During 6-month follow-up, patients also completed PROMs (the pain numeric rating scale, the Hip Disability and Osteoarthritis Outcome Score Joint Replacement [HOOS JR] and the Knee Injury and Osteoarthritis Outcome Score Joint Replacement [KOOS JR]), and HOOS or KOOS JR quality of life domain via a mobile-enabled web link.

Results

At least 6 months of follow-up was completed by 65% for THA and 68% for TKA patients. Reasons for non-completion included time commitment, phone battery, app issues, and health complications. Responses from 78% of requested PROMs were returned with 96% of patients returning at least one post-operative PROM. Step data were available from 92% of days from male patients and 86% of days from female patients. The most robust recovery occurred early, within the first 2 months. The groups with higher pre-operative steps were more likely to recover their maximum daily steps at an earlier time point. Correlations between step counts and PROMs scores were modest.

Conclusion

Assessing large amounts of post-TKA and post-THA step data using mobile technology is feasible. Completion rates were good, making the technology very useful for collecting frequent PROMs. Being unable to ensure that patients always carried their phones limited our analysis of the step counts.

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Acknowledgments

The authors thank Caroline Boyle, Isabel Wolfe, and Naomi Roselaar for their assistance in preparing this manuscript.

Funding

Stephen Lyman, PhD, was supported in part by funds from Weill Cornell Medicine, Grant No. 5UL1TR000457.

Author information

Correspondence to Stephen Lyman PhD.

Ethics declarations

Conflict of Interest

Chisa Hidaka, MD, Kara Fields, MS, and Wasif Islam, BS, declare that they have no conflicts of interest. Stephen Lyman, PhD, reports personal fees from Omni, Inc., JOSKAS, and Universal Research Solutions; editorial board membership at JBJS Statistics, outside the submitted work; and support for the current work in part by funds from the Clinical Translational Science Center (CTSC), National Center for Advancing Translational Sciences (NCATS) grant #5UL1TR000457. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding source NCATS, based in Rockville, MD. David Mayman, MD, discloses personal fees from Smith and Nephew, OrthAlign, and Imagen, outside the submitted work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

Informed Consent

Informed consent was obtained from all patients for being included in this study.

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Additional information

Level of Evidence: Level II: Prospective cohort study (therapeutic).

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Lyman, S., Hidaka, C., Fields, K. et al. Monitoring Patient Recovery After THA or TKA Using Mobile Technology. HSS Jrnl (2020). https://doi.org/10.1007/s11420-019-09746-3

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Keywords

  • mobile health
  • accelerometer
  • post-operative mobility
  • total joint arthroplasty