Early outcomes of primary total hip arthroplasty with use of a smartphone-based care platform: a prospective randomized controlled trial

Abstract

Aims The purpose of this study is to evaluate early outcomes with the use of a smartphone-based exercise and educational care management system after total hip arthroplasty (THA) and demonstrate decreased use of in-person physiotherapy (PT). Methods A multicentre, prospective randomized controlled trial was conducted to evaluate a smartphone-based care platform for primary THA. Patients randomized to the control group (198) received the institution’s standard of care. Those randomized to the treatment group (167) were provided with a smartwatch and smartphone application. PT use, THA complications, readmissions, emergency department/urgent care visits, and physician office visits were evaluated. Outcome scores include the Hip disability and Osteoarthritis Outcome Score (HOOS, JR), health-related quality-of-life EuroQol five-dimension five-level score (EQ-5D-5L), single leg stance (SLS) test, and the Timed Up and Go (TUG) test. Results The control group was significantly younger by a mean 3.0 years (SD 9.8 for control, 10.4 for treatment group; p = 0.007), but there were no significant differences between groups in BMI, sex, or preoperative diagnosis. Postoperative PT use was significantly lower in the treatment group (34%) than in the control group (55.4%; p = 0.001). There were no statistically significant differences in complications, readmissions, or outpatient visits. The 90-day outcomes showed no significant differences in mean hip flexion between controls (101° (SD 10.8)) and treatment (100° (SD 11.3); p = 0.507) groups. The HOOS, JR scores were not significantly different between control group (73 points (SD 13.8)) and treatment group (73.6 points (SD 13); p = 0.660). Mean 30-day SLS time was 22.9 seconds (SD 19.8) in the control group and 20.7 seconds (SD 19.5) in the treatment group (p = 0.342). Mean TUG time was 11.8 seconds (SD 5.1) for the control group and 11.9 (SD 5) seconds for the treatment group (p = 0.859). Conclusion The use of the smartphone care management system demonstrated similar early outcomes to those achieved using traditional care models, along with a significant decrease in PT use. Noninferiority was demonstrated with regard to complications, readmissions, and ED and urgent care visits. This technology allows patients to rehabilitate on a more flexible schedule and avoid unnecessary healthcare visits, as well as potentially reducing overall healthcare costs. Cite this article: Bone Joint J 2021;103-B(7 Supple B):91–97.

Logistic Regression Analysis of Risk Factors and Improvement of Clinical Treatment of Traumatic Arthritis after Total Hip Arthroplasty (THA) in the Treatment of Acetabular Fractures

“…In the past 30 years, active early open reduction and internal fixation for displaced acetabular fractures have been recognized by most scholars [ 14 ]. Although it can effectively reconstruct the anatomical structure of the acetabulum and restore its function, there are still some postoperative complications that affect the long-term efficacy due to many factors affecting the therapeutic effect, even if it is treated by experienced specialists [ 15 , 16 ]. According to the literature, it is reported that the incidence of traumatic arthritis after acetabular fracture is 20~30%, and the incidence of osteonecrosis of the femoral head is 2%~10% [ 17 ].…”

A Systematic Review of the Use of Commercial Wearable Activity Trackers for Monitoring Recovery in Individuals Undergoing Total Hip Replacement Surgery

“…Crawford et al [34] RoB 2.0 Some concerns The study is judged to raise some concerns in at least one domain for this result but not to be at high risk of bias for any domain.…”

“…The control groups mostly received the usual care as prescribed by the surgeon consisting of physiotherapy pre-and postsurgery and a single session in which they received information about the operation, walking with crutches, and exercises that would be performed in the postoperative phase [34][35][36]. The intervention groups received different interventions, including supervised sessions and training based on the patient's individual goals (a variety of vocational and recreational activi-ties such as basketball, golf, jogging, and curling) [35], 30minute walk per day [36], educational materials pre-and postoperatively [34], and home-based exercise program [34][35][36]. The home-based exercise programme involved six to eight exercises, performed three times per day, six days per week for six weeks postoperatively [34], training according to the principles of functional task exercise developed by Oosting et.…”

“…The intervention groups received different interventions, including supervised sessions and training based on the patient's individual goals (a variety of vocational and recreational activi-ties such as basketball, golf, jogging, and curling) [35], 30minute walk per day [36], educational materials pre-and postoperatively [34], and home-based exercise program [34][35][36]. The home-based exercise programme involved six to eight exercises, performed three times per day, six days per week for six weeks postoperatively [34], training according to the principles of functional task exercise developed by Oosting et. al and de Vreede et al [36][37][38], and exercises such as walking, climbing stairs, and rising out of a chair with symmetrical force and movement between the legs [35].…”

Follow-up after arthroplasty surgery

“…The use of smartphone-based rehabilitation has been assessed after primary partial knee, total knee, and total hip arthroplasties in prospective controlled trials using the Mymobility platform (Zimmer Biomet, USA). 34,35 Mymobility consists of a patient app accessible on both the iPhone and Apple Watch, as well as a web portal for clinicians that allows them to provide educational rehabilitation material, and view details on the patient’s engagement, activity levels, patient-reported outcome measures (PROMs), and messages. Early outcomes of smartphone-based care platforms demonstrate similar outcomes when compared to traditional physiotherapy care after partial/total knee and total hip arthroplasty.…”