Investigating Patient Satisfaction With Smart Knee Implants

Официальное название

Evaluating the Impact of Remote Therapeutic Monitoring on Knee Arthroplasty Recovery

Обзор

The main goal of this study is to see if there is a connection between the social and economic resources available in a patient's neighborhood (measured by the Area Deprivation Index, ADI) and their recovery after knee replacement surgery, as tracked through remote monitoring. A secondary goal is to find out if patients' self-reported pain and function score are linked to their actual physical improvement after surgery as measured by a remote therapeutic monitoring (RTM) device. Additionally, this study examines whether RTM can reduce the number of postoperative clinic visits within the first 90 days after surgery while maintaining patient satisfaction and patient-reported outcome measures (PROMs).

Подробное описание

Predicting and measuring knee function after total knee arthroplasty (TKA) has been a topic of debate in the field of orthopedic surgery for decades. The early recovery period after TKA is a critical time for achieving functional range of motion and mobility. For this reason, patients are traditionally examined at regular intervals during the postoperative period for evaluation. For patients who are not meeting targets during early recovery, interventions such as manipulation under anesthesia (MUA) or modifications to physical therapy protocols can improve outcomes. Remote therapeutic monitoring (RTM) using smart knee implants has been proposed as a means of enhancing postoperative follow-up with increased convenience to patients and without overburdening ambulatory resources. These smart knee implants collect objective recovery data including range-of-motion (ROM), step count, and cadence, and send these metrics to a mobile application so that patients and their practitioners can track their progress outside of the medical space. This study aims to compare post-operative patient-reported outcomes and satisfaction at multiple timepoints between patients with RTM and those with the current standard-of-care.

Insight into patient's functional recovery in their post-operative home environment may help orthopedic surgeons to better understand the impact of the social determinants of health (SDOH) on recovery. One of the methods of quantifying SDOH that has been popular in the healthcare field is the Area Deprivation Index (ADI). ADI was developed by the University of Wisconsin-Madison and uses patient addresses to display percentile-based information about neighborhood resources (including income, education, employment, and housing quality), quantifying healthcare accessibility. Some studies have found that while higher ADI may predict medical complications, non-home discharge, length of stay, and 90-day emergency department visits, there is low to no evidence that the metric is correlated with postoperative readmission rates, reoperation rates, or range of motion (ROM).Therefore, investigation into ADI as a predictor of outcomes following TKA needs to be further studied, particularly in juxtaposition with objective metrics of recovery.

The primary objective of this study is therefore to delineate if there is a correlation between the SDOH resources available to patients based on their home environment as measured by ADI, and remotely monitored functional outcomes after TKA . The secondary objective is to determine if patient-reported pain and function scores as measured by Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR.) correlate with remotely monitored functional improvement after TKA. The tertiary objective is to determine how patient satisfaction with surgery and postoperative recovery compares between patients with RTM and patients with standard knee replacements.

Вмешательства

• Устройство Smart Knee Implant
  An important advancement in objective recovery data occurred when the first ever 'smart' knee implant for remote therapeutic monitoring (RTM) after total knee arthroplasty (TKA) was released in 2021. The implant includes both a prosthesis for TKA and a stem, the latter of which records the following metrics: step count, distance traveled, tibial range-of-motion (ROM), functional ROM, average walking speed, stride length, and cadence. The implant sends the recordings to a mobile platform. Additio

Первичные конечные точки

• Patient-Reported Outcomes and Satisfaction [Срок оценки: From enrollment to 1 year after arthroplasty]

Вторичные конечные точки (3)

• Area Deprivation Index Correlation with Recovery [Срок оценки: up to 1 year]
• Correlation between Knee Injury and Osteoarthritis Outcome score for Joint Replacement (KOOS, JR.) and smart knee implant recovery curve percentiles [Срок оценки: From enrollment to 1 year after arthroplasty]
• Complications after Knee Arthroplasty [Срок оценки: From enrollment to 1 year after arthroplasty]

Критерии участия

Критерии включения

• Patients over 18 years of age
• Patients undergoing unilateral primary or revision total knee arthroplasty with the smart knee implant or standard-of-care

Критерии исключения

• Patients who receive contralateral knee replacement or contralateral or unilateral hip replacement within 90 days before or after their knee replacement in this study
• Patients with post-operative weight-bearing restrictions or physical deconditioning prohibiting routine physical therapy participation

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Да

Дизайн исследования

Распределение

Нерандомизированное

Модель

Параллельные группы

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

США · 1 центр

• The University of Chicago Medical Center — Chicago

Публикации

• Yocum D, Housholder E, Yergler J. Manipulation under Anesthesia Following TKA with Persona IQ: A Case Series. J Orthop Case Rep. 2023 Aug;13(8):127-131. doi: 10.13107/jocr.2023.v13.i08.3844. PMID 37654748
• Yocum D, Elashoff B, Verta P, Armock G, Yergler J. Patient reported outcomes do not correlate to functional knee recovery and range of motion in total knee arthroplasty. J Orthop. 2023 Jul 27;43:36-40. doi: 10.1016/j.jor.2023.07.009. eCollection 2023 Sep. PMID 37564705
• Shimizu MR, Buddhiraju A, Lin-Wei Chen T, Huang Z, Chen SF, Xiao P, RezazadehSaatlou M, Kwon YM. Socioeconomic area deprivation index is not associated with postoperative complications following revision total hip and knee joint arthroplasty. J Orthop. 2024 Jul 17;58:135-139. doi: 10.1016/j.jor.2024.07.008. eCollection 2024 Dec. PMID 39100544
• Calkins FM, Pagani NR, Bragg J, Gauthier Z, Salzler M. Neighborhood socioeconomic disadvantage does not predict need for manipulation under anesthesia or range of motion following total knee arthroplasty. J Orthop. 2024 Jun 15;58:146-149. doi: 10.1016/j.jor.2024.06.013. eCollection 2024 Dec. PMID 39100542
• Jevnikar BE, Huffman N, Roth A, Klika AK, Deren ME, Zhang C, Piuzzi NS; CCARR Corporate Authorship. Impacts of neighborhood deprivation on septic and aseptic revision total knee arthroplasty outcomes: A comprehensive analysis using the area deprivation index. Knee. 2024 Dec;51:74-83. doi: 10.1016/j.knee.2024.08.006. Epub 2024 Sep 5. PMID 39241673
• Shimizu MR, Buddhiraju A, Kwon OJ, Kerluku J, Huang Z, Kwon YM. The Utility of Neighborhood Social Vulnerability Indices in Predicting Non-Home Discharge Disposition Following Revision Total Joint Arthroplasty: A Comparison Study. J Arthroplasty. 2025 May;40(5):1148-1153. doi: 10.1016/j.arth.2024.10.118. Epub 2024 Oct 25. PMID 39490785
• Gordon AM, Ng MK, Elali F, Piuzzi NS, Mont MA. A Nationwide Analysis of the Impact of Socioeconomic Status on Complications and Health Care Utilizations After Total Knee Arthroplasty Using the Area Deprivation Index: Consideration of the Disadvantaged Patient. J Arthroplasty. 2024 Sep;39(9):2166-2172. doi: 10.1016/j.arth.2024.04.028. Epub 2024 Apr 12. PMID 38615971
• Zimmer Biomet and Canary Medical Announce FDA De Novo Classification Grant and Authorization to Market the World's First and Only Smart Knee Implant n.d. http://investor.zimmerbiomet.com/news-and-events/news/2021/08-30-2021-120155075 (accessed December 12, 2024).

Идентификаторы

NCT: NCT06968143 · IRB25-0508

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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