Digital monitoring and rehabilitation after knee arthroplasty: a longitudinal cohort study

Research Objectives: To investigate the engagement, safety, clinical effectiveness, and satisfaction of an app-based digital monitoring and rehabilitation program after Total knee arthroplasty (TKA).

Design: This interventional study was performed between January 2021 and May 2022 and patients were followed up up to 6 months after surgery

Setting: Home-exercising supported by a digital application

Participants: 127 patients

Interventions: The setup involved a mobile app for patients and a web portal for physical therapists (PTs). The portal enabled daily monitoring of patient data by PTs, allowing them to adjust protocols. Patients used the app for daily exercise programs and reported their compliance. Educational articles were sent to patients based on their progress, and patients wore an activity tracker at all times.

Main Outcome Measures: The app collected KOOS and complications, unplanned consultations, readmissions, and drop-out rates, including the patient’s reasons. Undesired events reported by the patient were managed through a smart alert system. When necessary, the doctor was alerted to any concerns.

Results: 14 patients did not start, and 12 did not continue after surgery. Of the 87 analyzed patients, there was only a 1% readmission rate. A total of 67 alerts were raised for 32 patients. The doctor's most common actions included changing medication (27%), providing wound information and reassurance (15%), and making referrals (15%), leading to 10 in-person consultations. Adherence to the exercise program was 79%. Significant improvements were noted at six months after surgery across all KOOS sub-scales: Pain (14-point increase), Symptoms (20-point increase), Function (22-point increase), and Quality of Life (26-point increase). When asked if they would opt for digital rehabilitation again, 89% of patients responded affirmatively.

Conclusions: For those receiving a TKA, digital rehab could enhance postoperative care access and cut healthcare expenses by decreasing complications and readmissions. Additionally, utilizing this app-based program resulted in greater adherence to home exercises compared to traditional rehabilitation.

Author(s) Disclosures: JL, AP, C Mc are employed by the company who developed the digital application.
P VO is a co-founder of the same company