Download PDF
J Knee Surg
DOI: 10.1055/a-2525-4672
Special Focus Section

Utilization of Smartphone Technology and Wearable Technology Following TKA

Adam M. Gordon
1   Questrom School of Business, Boston University, Boston, Massachusetts
2   Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, New York
,
Awais Hussain
3   Department of Orthopaedic Surgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, New York, New York
,
Michael A. Mont
4   The Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

The widespread adoption of smartphones and wearable technology has introduced innovative approaches in health care, particularly in postoperative rehabilitation. These technologies hold significant promise for improving recovery following lower extremity arthroplasty, especially total knee arthroplasty (TKA). Despite growing interest, the evidence on their effectiveness and long-term impact remains variable.

This narrative review evaluates the utilization of smartphone applications, wearable devices, and their combined use in postoperative recovery after TKA. Key studies assessing adherence, functional outcomes, patient satisfaction, and health care utilization were analyzed to synthesize insights into their effectiveness compared to traditional rehabilitation approaches.

Smartphone applications have demonstrated improvements in adherence to rehabilitation plans, pain management, and functional outcomes. For instance, interventions using text-based prompts or interactive platforms enhanced physical activity, reduced narcotic use, and improved patient-reported outcomes such as PROM adherence and range of motion (ROM). Similarly, wearable devices provided accurate feedback on activity levels and step counts, promoting early mobility and strength recovery. Combined approaches leveraging both technologies further enhanced adherence, functional recovery, and patient engagement while reducing health care utilization.

The integration of smartphone and wearable technologies in TKA rehabilitation shows potential for improving recovery outcomes. While findings generally indicate noninferiority or superiority to conventional methods, limitations exist in standardization, data accuracy, and long-term benefits. Future research should focus on refining these technologies, establishing standardized guidelines, and evaluating their cost-effectiveness in diverse populations. Smartphone and wearable technologies represent safe and effective tools for enhancing postoperative outcomes in TKA patients. Their integration into clinical practice could optimize rehabilitation protocols, improve patient engagement, and potentially reduce health care costs.

Keywords

smartphone applications - sensors - technology - rehabilitation - total knee arthroplasty


Publication History

Received: 05 January 2025

Accepted: 26 January 2025

Accepted Manuscript online:
27 January 2025

Article published online:
11 March 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Faverio M. Share of those 65 and older who are tech users has grown in the past decade. Pew Research Center; 2022
    Search in Google Scholar
  • 2 Feng Y, Liu Y, Fang Y. et al. Advances in the application of wearable sensors for gait analysis after total knee arthroplasty: a systematic review. Arthroplasty 2023; 5 (01) 49
    CrossrefPubMedSearch in Google Scholar
  • 3 Abdeen A, Monárrez R, Drew JM, Kennedy KF. Use of a smart-phone mobile application is associated with improved compliance and reduced length of stay in patients undergoing primary total joint arthroplasty of the hip and knee. J Arthroplasty 2022; 37 (08) 1534-1540
    CrossrefPubMedSearch in Google Scholar
  • 4 Sousa Lima W, Souto E, El-Khatib K, Jalali R, Gama J. Human activity recognition using inertial sensors in a smartphone: an overview. Sensors (Basel) 2019; 19 (14) 3213
    CrossrefPubMedSearch in Google Scholar
  • 5 Straczkiewicz M, James P, Onnela JP. A systematic review of smartphone-based human activity recognition methods for health research. NPJ Digit Med 2021; 4 (01) 148
    CrossrefPubMedSearch in Google Scholar
  • 6 Gianzina E, Kalinterakis G, Delis S, Vlastos I, Platon Sachinis N, Yiannakopoulos CK. Evaluation of gait recovery after total knee arthroplasty using wearable inertial sensors: a systematic review. Knee 2023; 41: 190-203
    CrossrefPubMedSearch in Google Scholar
  • 7 Christensen JC, Stanley EC, Oro EG. et al. The validity and reliability of the OneStep smartphone application under various gait conditions in healthy adults with feasibility in clinical practice. J Orthop Surg Res 2022; 17 (01) 417
    CrossrefPubMedSearch in Google Scholar
  • 8 Raje S, Shetty AG, Shetty S, Bhuptani B, Arun Maiya G. Application of digital technology in rehabilitation of total knee arthroplasty: a systematic review. J Orthop 2024; 54: 108-115
    CrossrefPubMedSearch in Google Scholar
  • 9 Small SR, Bullock GS, Khalid S, Barker K, Trivella M, Price AJ. Current clinical utilisation of wearable motion sensors for the assessment of outcome following knee arthroplasty: a scoping review. BMJ Open 2019; 9 (12) e033832
    CrossrefPubMedSearch in Google Scholar
  • 10 Patel S, Park H, Bonato P, Chan L, Rodgers M. A review of wearable sensors and systems with application in rehabilitation. J Neuroeng Rehabil 2012; 9: 21
    CrossrefPubMedSearch in Google Scholar
  • 11 Hameed D, Sodhi N, Dubin J, Schneider A, Barrack RL, Mont MA. Integrating Smartphone applications and wearable devices for postoperative rehabilitation in total knee arthroplasty: a critical review. J Arthroplasty 2024; 39 (08) 2028-2039.e1
    CrossrefPubMedSearch in Google Scholar
  • 12 Kurtz SM, Higgs GB, Chen Z. et al. Patient perceptions of wearable and smartphone technologies for remote outcome monitoring in total knee arthroplasties. J Knee Surg 2023; 36 (12) 1253-1258
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Çankaya D, Aktı S, Ünal SB, Sezgin EA. Unicompartmental knee arthroplasty results in a better gait pattern than total knee arthroplasty: Gait analysis with a smartphone application. Jt Dis Relat Surg 2021; 32 (01) 22-27
    PubMedSearch in Google Scholar
  • 14 Msayib Y, Gaydecki P, Callaghan M, Dale N, Ismail S. An intelligent remote monitoring system for total knee arthroplasty patients. J Med Syst 2017; 41 (06) 90
    CrossrefPubMedSearch in Google Scholar
  • 15 Jenny JY, Bureggah A, Diesinger Y. Measurement of the knee flexion angle with smartphone applications: Which technology is better?. Knee Surg Sports Traumatol Arthrosc 2016; 24 (09) 2874-2877
    CrossrefPubMedSearch in Google Scholar
  • 16 Iyengar KP, Gowers BTV, Jain VK, Ahluwalia RS, Botchu R, Vaishya R. Smart sensor implant technology in total knee arthroplasty. J Clin Orthop Trauma 2021; 22: 101605
    CrossrefPubMedSearch in Google Scholar
  • 17 Chiang CY, Chen KH, Liu KC, Hsu SJ, Chan CT. Data collection and analysis using wearable sensors for monitoring knee range of motion after total knee arthroplasty. Sensors (Basel) 2017; 17 (02) 418
    CrossrefPubMedSearch in Google Scholar
  • 18 Knapp PW, Keller RA, Mabee KA, Shi J, Pillai R, Frisch NB. Comparison of a smartphone app to manual knee range of motion measurements. Arthroplast Today 2022; 15: 43-46
    CrossrefPubMedSearch in Google Scholar
  • 19 Tripuraneni KR, Foran JRH, Munson NR, Racca NE, Carothers JT. A smartwatch paired with a mobile application provides postoperative self-directed rehabilitation without compromising total knee arthroplasty outcomes: a randomized controlled trial. J Arthroplasty 2021; 36 (12) 3888-3893
    CrossrefPubMedSearch in Google Scholar
  • 20 Pfeufer D, Monteiro P, Gililland J. et al. Immediate postoperative improvement in gait parameters following primary total knee arthroplasty can be measured with an insole sensor device. J Knee Surg 2022; 35 (06) 692-697
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Patterson JT, Wu HH, Chung CC, Bendich I, Barry JJ, Bini SA. Wearable activity sensors and early pain after total joint arthroplasty. Arthroplast Today 2020; 6 (01) 68-70
    CrossrefPubMedSearch in Google Scholar
  • 22 Bäcker HC, Wu CH, Schulz MRG, Weber-Spickschen TS, Perka C, Hardt S. App-based rehabilitation program after total knee arthroplasty: a randomized controlled trial. Arch Orthop Trauma Surg 2021; 141 (09) 1575-1582
    CrossrefPubMedSearch in Google Scholar
  • 23 Vegesna A, Tran M, Angelaccio M, Arcona S. Remote patient monitoring via non-invasive digital technologies: a systematic review. Telemed J E Health 2017; 23 (01) 3-17
    CrossrefPubMedSearch in Google Scholar
  • 24 Gordon AM, Nian P, Baidya J, Scuderi G, Mont MA. Randomized controlled studies on smartphone applications and wearable devices for postoperative rehabilitation after total knee arthroplasty: a systematic review. J Arthroplasty 2025; (e-pub ahead of print)
    CrossrefPubMedSearch in Google Scholar
  • 25 Zhang H, Wang J, Jiang Z, Deng T, Li K, Nie Y. Home-based tele-rehabilitation versus hospital-based outpatient rehabilitation for pain and function after initial total knee arthroplasty: a systematic review and meta-analysis. Medicine (Baltimore) 2023; 102 (51) e36764
    CrossrefPubMedSearch in Google Scholar
  • 26 Tsang MP, Man GCW, Xin H, Chong YC, Ong MT, Yung PS. The effectiveness of telerehabilitation in patients after total knee replacement: a systematic review and meta-analysis of randomized controlled trials. J Telemed Telecare 2024; 30 (05) 795-808
    CrossrefPubMedSearch in Google Scholar
  • 27 Alrawashdeh W, Eschweiler J, Migliorini F, El Mansy Y, Tingart M, Rath B. Effectiveness of total knee arthroplasty rehabilitation programmes: a systematic review and meta-analysis. J Rehabil Med 2021; 53 (06) jrm00200
    CrossrefPubMedSearch in Google Scholar
  • 28 Campbell KJ, Louie PK, Bohl DD. et al. A novel, automated text-messaging system is effective in patients undergoing total joint arthroplasty. J Bone Joint Surg Am 2019; 101 (02) 145-151
    CrossrefPubMedSearch in Google Scholar
  • 29 Miller MD, Redfern RE, Anderson MB, Abshagen S, Van Andel D, Lonner JH. Completion of patient-reported outcome measures improved with use of a mobile application in arthroplasty patients: results from a randomized controlled trial. J Arthroplasty 2024; 39 (07) 1656-1662
    CrossrefPubMedSearch in Google Scholar
  • 30 Nuevo M, Rodríguez-Rodríguez D, Jauregui R. et al. Telerehabilitation following fast-track total knee arthroplasty is effective and safe: a randomized controlled trial with the ReHub® platform. Disabil Rehabil 2024; 46 (12) 2629-2639
    CrossrefPubMedSearch in Google Scholar
  • 31 Timmers T, Janssen L, van der Weegen W. et al. The effect of an app for day-to-day postoperative care education on patients with total knee replacement: randomized controlled trial. JMIR Mhealth Uhealth 2019; 7 (10) e15323
    CrossrefPubMedSearch in Google Scholar
  • 32 Delanois R, Sodhi N, Acuna A, Doll K, Mont MA, Bhave A. Use of home neuromuscular electrical stimulation in the first 6 weeks improves function and reduces pain after primary total knee arthroplasty: a matched comparison. Ann Transl Med 2019; 7 (Suppl. 07) S254
    CrossrefPubMedSearch in Google Scholar
  • 33 Choudhury AK, Bansal S, Jain A, Raja BS, Niraula BB, Kalia RB. Conventional rehabilitation post-TKA achieves better knee flexion with higher resource utilization compared to application-based rehabilitation - a systematic review and meta-analysis. J Orthop 2023; 44: 77-85
    CrossrefPubMedSearch in Google Scholar
  • 34 Özden F, Sarı Z. The effect of mobile application-based rehabilitation in patients with total knee arthroplasty: a systematic review and meta-analysis. Arch Gerontol Geriatr 2023; 113: 105058
    CrossrefPubMedSearch in Google Scholar
  • 35 Alexander JS, Redfern RE, Duwelius PJ, Berend KR, Lombardi Jr AV, Crawford DA. Use of a smartphone-based care platform after primary partial and total knee arthroplasty: 1-year follow-up of a prospective randomized controlled trial. J Arthroplasty 2023; 38 (7 Suppl 2): S208-S214
    CrossrefPubMedSearch in Google Scholar
  • 36 Huang P, He J, Zhang YM. [The mobile application of patient management in education and follow-up for patients following total knee arthroplasty]. Zhonghua Yi Xue Za Zhi 2017; 97 (20) 1592-1595
    PubMedSearch in Google Scholar
  • 37 Hardt S, Schulz MRG, Pfitzner T. et al. Improved early outcome after TKA through an app-based active muscle training programme-a randomized-controlled trial. Knee Surg Sports Traumatol Arthrosc 2018; 26 (11) 3429-3437
    CrossrefPubMedSearch in Google Scholar
  • 38 Duong V, Dennis S, Ferreira ML. et al. Predictors of adherence to a step count intervention following total knee replacement: an exploratory cohort study. J Orthop Sports Phys Ther 2022; 52 (09) 620-629
    CrossrefPubMedSearch in Google Scholar
  • 39 Koseki K, Mutsuzaki H, Yoshikawa K. et al. Early recovery of walking ability in patients after total knee arthroplasty using a hip-wearable exoskeleton robot: a case-controlled clinical trial. Geriatr Orthop Surg Rehabil 2021 ;12:21514593211027675
    PubMedSearch in Google Scholar
  • 40 Van der Walt N, Salmon LJ, Gooden B. et al. Feedback from activity trackers improves daily step count after knee and hip arthroplasty: a randomized controlled trial. J Arthroplasty 2018; 33 (11) 3422-3428
    CrossrefPubMedSearch in Google Scholar
  • 41 Ference D, Ference RJ, Rempher E, Freeman DC. Total knee arthroplasty patients using the in-home X10 machine fully recovered. No additional therapy required. J Orthop 2021; 27: 79-83
    CrossrefPubMedSearch in Google Scholar
  • 42 Lou N, Diao Y, Chen Q. et al. A portable wearable inertial system for rehabilitation monitoring and evaluation of patients with total knee replacement. Front Neurorobot 2022; 16: 836184
    CrossrefPubMedSearch in Google Scholar
  • 43 Bini SA, Shah RF, Bendich I, Patterson JT, Hwang KM, Zaid MB. Machine learning algorithms can use wearable sensor data to accurately predict six-week patient-reported outcome scores following joint replacement in a prospective trial. J Arthroplasty 2019; 34 (10) 2242-2247
    CrossrefPubMedSearch in Google Scholar
  • 44 Mehta SJ, Hume E, Troxel AB. et al. Effect of remote monitoring on discharge to home, return to activity, and rehospitalization after hip and knee arthroplasty: a randomized clinical trial. JAMA Netw Open 2020; 3 (12) e2028328
    CrossrefPubMedSearch in Google Scholar
  • 45 Ramkumar PN, Haeberle HS, Ramanathan D. et al. Remote patient monitoring using mobile health for total knee arthroplasty: validation of a wearable and machine learning-based surveillance platform. J Arthroplasty 2019; 34 (10) 2253-2259
    CrossrefPubMedSearch in Google Scholar
  • 46 Crawford DA, Duwelius PJ, Sneller MA. et al. 2021 Mark Coventry Award: Use of a smartphone-based care platform after primary partial and total knee arthroplasty: a prospective randomized controlled trial. Bone Joint J 2021; 103-B (6 Supple A): 3-12
    CrossrefPubMedSearch in Google Scholar
  • 47 van Dijk-Huisman HC, Weemaes ATR, Boymans TAEJ, Lenssen AF, de Bie RA. Smartphone app with an accelerometer enhances patients' physical activity following elective orthopedic surgery: a pilot Study. Sensors (Basel) 2020; 20 (15) 4317
    CrossrefPubMedSearch in Google Scholar