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Total Knee Arthroplasty (TKA) is frequently performed for advanced osteoarthritis, with patient-reported outcome measures (PROMs) traditionally reporting on efficacy. These subjective evaluations, although useful, may inaccurately reflect post-TKA activity levels. With technological advancements, smart implantable devices (SIDs) offer objective, real-time gait metrics, potentially providing a more accurate postoperative recovery assessment. This study compares these objective metrics with PROMs to evaluate TKA success more effectively. We conducted a retrospective cohort study with 88 participants undergoing TKA using a SID. Eligible patients were aged 18 years or older and had advanced osteoarthritis. We excluded those who had bilateral TKAs, joint infections, or neuromuscular disease. The SID system collected daily gait metrics, including step count, distance traveled, walking speed, stride length, cadence, and functional knee range of motion. The PROMs, including Knee Injury and Osteoarthritis Outcome Score–Joint Replacement, Veterans Rand 12 Physical Component Summary, and Veterans Rand 12 Mental Component Summary, were analyzed against SID gait metrics. Among the 88 patients, 80 provided continuous data over 12 weeks. All gait metrics, except stride length, significantly increased at the 12-week point (P <.05). The PROMs also significantly improved postoperatively (P <.05). Initial low positive correlations between 12-week PROMs and SID metrics decreased after adjusting for demographic variables, leaving only weak correlations between the Veterans Rand 12 Physical Component Summary and Knee Injury and Osteoarthritis Outcome Score–Joint Replacement with functional knee range of motion (r = 0.389, P =.002; r = 0.311, P =.014, respectively), and Veterans Rand 12 Mental Component Summary with step count (r = 0.406, P =.001) and distance traveled (r = 0.376, P =.003). This study indicates that both PROMs and SID gait metrics show significant improvements post-TKA, though they correlate weakly with each other, suggesting a possible discrepancy between perceived recovery and actual functional improvement. The SID gait metrics might provide a valuable addition to traditional PROMs by offering an objective representation of physical capabilities unaffected by patient compliance or subjective perceptions of recovery. Further research is needed to validate these findings in larger populations and to explore whether integrating SID metrics can enhance long-term functional outcomes. [ABSTRACT FROM AUTHOR]

A growing number of total knee arthroplasty (TKA) patients are candidates for same-day discharge (SDD). Previous research has shown that internet-based remote physical therapy (RPT) can produce equivalent outcomes to supervised outpatient physical therapy (OPT) after TKA. We sought to compare outcomes between RPT and OPT in patients undergoing SDD TKA using an electronic remote perioperative management (ERPM) program. Patients undergoing SDD TKA were enrolled in an ERPM program and randomized to ERPM + RPT or ERPM + OPT. Preoperative and 6-week functional assessments included knee range of motion, timed up and go, and 4-meter gait speed. Numerical Rating Scale pain scores were evaluated preoperatively, at 6 and 12 weeks, and satisfaction was assessed at 6, 12, and 52 weeks postoperatively. Participants completed the Veterans Rand 12 Item Health Survey and Knee Injury and Osteoarthritis Outcome Score preoperatively and at 6, 12, and 52 weeks postoperatively. OPT utilization was collected 90 days postoperatively. Of 197 initially randomized patients, 76 remained in the ERPM + RPT group and 95 in the ERPM + OPT group after withdrawals and crossovers. Baseline characteristics showed no differences between the 2 groups. No clinically relevant differences were observed in knee range of motion, Numerical Rating Scale pain, patient-reported outcomes, functional assessments, or satisfaction at any follow-up time. Participants in the ERPM + OPT group attended an average of 11.57 physical therapy sessions, incurring a total cost of $462.8 and 133 minutes of travel. Conversely, the ERPM + RPT group experienced no expenses or travel time. Patients in the ERPM + RPT group had similar outcomes, lower costs, and saved time compared to patients in the ERPM + OPT group after SDD TKA. Further analysis is needed to determine predictive indicators for crossovers. [ABSTRACT FROM AUTHOR]

Background: Demand for total hip arthroplasty (THA) in ambulatory surgery centers (ASCs) is rapidly increasing. Increased efficiency is crucial in ASCs to manage this rising demand, particularly considering different surgical approaches and their varying time requirements. Optimizing efficiency can help meet the demand while ensuring safe and timely same-day discharge (SDD). This study examined the time spent in each care phase for THA patients in an outpatient ASC, the success rate and delays of SDD, and operative outcomes including estimated blood loss, 90-day complication rates, and 1-year patient-reported outcomes., Methods: A retrospective review was performed between January 1, 2019 and January 1, 2021 for all primary THA patients in a single free-standing ASC. Demographics, baseline functions, phase of care times, perioperative outcomes, 90 day complications, and patient-reported outcomes were recorded and compared stratified by surgical approach. Comparison was done using two-tailed t-tests and Fisher's exact tests. Multivariate both-direction stepwise regression analyses were performed to control for differences in group demographic factors such as age, sex, body mass index (BMI), preoperative assistive device use, attendance at preoperative class, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index, and preoperative diagnosis., Results: Our groups differed in age, BMI, assistive device use, preoperative class attendance, and preoperative Veterans Rand 12 Item Health Survey (VR-12) physical component score (PCS). The direct anterior approach (DAA) and posterior approach (PA) cohorts varied significantly in minutes spent in each phase of care except for Spinal Time and Total physical therapy (PT) Time in Post-Anesthesia Care Unit (PACU). Direct Anterior Approach was faster that PA in Spinal State to Incision Time (26.8 ± 10.9 versus 35.0 ± 10.1; P < 0.001), Set-up/Take-down Time (20.5 ± 5.8 versus 30.2 ± 8.2; P < 0.001), Operative Time (37.5 ± 14.5 versus 50.4 ± 6.7; P < 0.001), Total operating room (OR) Time (57.8 ± 17.4 versus 80.5 ± 11.4; P < 0.001), and Arrival to Discharge Time (383.8 ± 71.2 versus 418.4 ± 60.8; P < 0.001). The PA was faster than DAA in Time to Initiation of PT (46.3 ± 25.1 versus 71.4 ± 34.7; P < 0.001), PACU Arrival to PT Cleared Time (124.9 ± 42.3 versus 144.3 ± 47.8; P < 0.001), and Total PACU Time (127.8 ± 47.4 versus 143.4 ± 47.8; P < 0.001). Surgical approach, age, BMI, and preoperative use of an assistive device were the most common predictive factors for phase of care time differences. Excessive spinal was the most common reason to delay physical therapy. The 90 day complications were not associated with surgical approach and patient-reported outcomes at 12, 26, or 52 weeks showed no significant differences., Conclusion: Direct anterior surgical approach showed shorter arrival to discharge time, and total OR time compared to PA with similar patient-reported outcomes (PROs) and complications. Both approaches were equally effective at achieving SDD. Operative time and set-up/take-down time were the main drivers of improved efficiency in the DAA group. Time to initiation of PT was prolonged in the DAA group, due to a standard spinal block time with a shorter OR time., (Copyright © 2024 Elsevier Inc. All rights reserved.)