BACKGROUND:To regain range of motion (ROM) after total knee arthroplasty, manipulation under anesthesia (MUA) may be recommended; however, restoration of gait following MUA requires clarification. The purpose of this study was to compare gait quality metrics, function, and ROM between stiff-kneed patients who underwent and did not undergo MUA. METHODS:This study was a secondary data analysis of a large multicenter, observational cohort study in which patients used a digital care management platform with a smartwatch before and after total knee arthroplasty. Patients who had active flexion less than 90° at one month postoperatively were divided by occurrence of MUA (MUA: n = 52; non-MUA: n = 218). Patient recovery following MUA was evaluated via active flexion ROM, Knee Osteoarthritis and Outcomes Scale for Joint Replacement (KOOS JR), and objective gait metrics. RESULTS:On average, gait metrics of participants who received an MUA decreased 1 to 8 percentiles compared to non-MUA patients immediately post-MUA, with significant differences between cohorts at five days post-MUA for walking speed (P = 0.02) and step count (P = 0.05), but not walking asymmetry (P = 0.09). All gait metrics were similar between cohorts at 10-days through 30-days post-MUA (P = 0.05). There were no significant (P = 0.09) differences in preoperative ROM between the MUA and non-MUA cohort, but ROM was reduced in the MUA cohort at one (75.0 versus 80°, P = 0.002) and three months (105 versus 115°, P = 0.048) postoperative. Similarly, KOOS JR did not differ significantly between cohorts preoperatively (P = 0.960), but was significantly (P = 0.0021) lower in the MUA cohort at three months, six months, and 12 months postoperative. CONCLUSIONS:Gait metrics normalized within five to 10 days after MUA, whereas KOOS JR scores remained lower in the MUA cohort for up to one year, highlighting a disconnect between objective and patient-reported outcomes. These findings underscore the importance of surgeon awareness when counseling patients about the expected recovery trajectory after MUA.

Background Direct anterior approach (DAA) has become increasingly utilized for total hip arthroplasty (THA). Proponents cite faster recovery and less pain. However, most studies comparing approaches utilize different implants. Additionally, little is known about postoperative sleep quality between approaches. The purpose of this study was to compare step counts, pain, patient-reported outcomes (PROMs), and sleep quality within first 12-weeks of DAA and posterior approach (PA) THA utilizing the same implants. Methods This was a single-institution, prospective, cohort study of 94 THAs (45 direct-anterior approach (DAA), 49 posterior approach (PA)) utilizing the same triple-tapered stem and hemispherical shell. Demographics were similar, but DAA had lower BMI (27 vs 30, p<0.05). Patients with unilateral hip osteoarthritis (OA), BMI <40, without prior hip surgery, and ability to use wrist-based wearable device (FitBit) were included. Step count was measured daily for 12-weeks. PROMs were assessed at preop, 3-weeks, 6-weeks, and 12-weeks, and included Hip disability and Osteoarthritis Outcome Score Jr. (HOOS Jr), Forgotten Joint Score (FJS), and VAS (Visual Analog Pain Score). Patients completed Pittsburgh Sleep Quality Index (PSQI) at 30, 60, and 90-days postoperatively. T-test was performed. Results There were no differences between DAA and PA in step count change from preop to any time point up to 12 weeks (P>0.05). There were no differences in VAS, HOOS Jr, or FJS at any timepoint (p>0.05). There were no differences between DAA and PA in overall PSQI score, PSQI sleep quantity score, or monitor recorded hours of sleep at any time point (P>0.05). Conclusion This prospective study utilizing daily remote monitoring and the same implants did not identify a difference in THA by DAA or PA with regards to functional recovery, pain, or sleep quality in the early postoperative period.

Background: We previously reported the 5-year results of the Birmingham Hip Resurfacing (BHR) implant. This study evaluates BHR survivorship as well as radiographic and clinical outcomes at long-term follow-up. Methods: A total of 224 patients with contemporary indications, including 179 patients from the original study, were included in this analysis. Survivorship was calculated. Metal ion levels and radiographs were updated. Patient-reported outcomes (PROs) were compared with those for matched patients who had undergone total hip arthroplasty (THA). The mean follow-up was 14 years. Results: Survivorship free from any revision and from aseptic revision was 96.0% and 97.4% at 15 years, respectively. Two patients had undergone revision since the original study. The median serum cobalt and chromium levels were 1.4 and 1.5 ppb, respectively. The PROs were similar to those for the THA cohort. Equal proportions of patients remained active; however, the BHR group trended toward more remaining highly active (p = 0.12). Conclusions: Although activity was similar to THA at long-term follow-up, the BHR implant remains an excellent option for the treatment of osteoarthritis in younger male patients. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

BACKGROUND:The purpose of this multicenter, double-blinded, prospective, randomized controlled trial was to determine the safest and most effective dose of intravenous (IV) dexamethasone administered during primary total knee arthroplasty (TKA). METHODS:There were 404 patients undergoing inpatient primary TKA randomized across 11 centers to receive four (n = 138), eight (n = 137), or 16 mg (n = 129) of IV dexamethasone intraoperatively. All sites utilized the same perioperative multimodal protocol. Opioid consumption measured in morphine milligram equivalents (MME), pain scores, nausea scores, vomiting episodes, and sleep duration was collected for 7 days postoperatively. Glucose levels were measured on postoperative day 1 (POD1). The mean age was 68 years, the mean body mass index was 33, and 62% were women. Independent sample t-tests were used for continuous data, and Chi-square and Fisher's exact tests were used for discrete data. Demographic characteristics were comparable between groups, suggesting successful randomization. RESULTS:Patients who received 16 mg IV dexamethasone consumed less MME on POD1 (38 versus 37 versus 27 MME; P = 0.047) and had fewer vomiting episodes (P = 0.02). Patients who received 16 mg also had lower pain scores at rest at 24 hours, 48 hours, and one week. There were no differences in cumulative opioid consumption within the first 48 hours (P = 0.24), one week (P = 0.43), or pain with activity at any time point. The POD1 glucose was highest in patients who received 16 mg (P < 0.001). There were no differences in length of stay, hours slept, or 90-day complication rates between groups. CONCLUSIONS:High-dose (16 mg) IV dexamethasone in TKA reduces opioid consumption, pain, and vomiting on the first day after surgery. Outcomes, including opioid consumption, sleep, and nausea, are comparable beyond 24 hours for all doses. LEVEL OF EVIDENCE:I. Prospective randomized controlled trial.

BACKGROUND:We previously reported the 5-year results of the Birmingham Hip Resurfacing (BHR) implant. This study evaluates BHR survivorship as well as radiographic and clinical outcomes at long-term follow-up. METHODS:A total of 224 patients with contemporary indications, including 179 patients from the original study, were included in this analysis. Survivorship was calculated. Metal ion levels and radiographs were updated. Patient-reported outcomes (PROs) were compared with those for matched patients who had undergone total hip arthroplasty (THA). The mean follow-up was 14 years. RESULTS:Survivorship free from any revision and from aseptic revision was 96.0% and 97.4% at 15 years, respectively. Two patients had undergone revision since the original study. The median serum cobalt and chromium levels were 1.4 and 1.5 ppb, respectively. The PROs were similar to those for the THA cohort. Equal proportions of patients remained active; however, the BHR group trended toward more remaining highly active (p = 0.12). CONCLUSIONS:Although activity was similar to THA at long-term follow-up, the BHR implant remains an excellent option for the treatment of osteoarthritis in younger male patients. LEVEL OF EVIDENCE:Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Aims:The aim of this study was to compare the early clinical outcomes of robotically-assisted total knee arthroplasty (RA-TKA) and manual total knee arthroplasty (M-TKA), using daily remote patient monitoring. Methods:We prospectively enrolled and compared patients who underwent 95 RA-TKAs with those who underwent 114 M-TKAs. All patients used an activity monitor and a patient engagement platform for two weeks preoperatively and 90 days postoperatively to collect daily visual analogue scale (VAS) pain scores, opioid consumption (in morphine milligram equivalents (MMEs)), step counts, weekly Oxford Knee Scores (OKSs), and monthly Forgotten Joint Scores (FJS). There were no significant differences between groups in sex or BMI. Patients in the RA-TKA group were significantly younger (mean age 63 vs 65 years; p = 0.006). Independent-samples t-tests, chi-squared tests, and Fisher's exact tests were used for statistical analysis. Results:RA-TKA led to significantly decreased pain (mean VAS 3.6 vs 4.2; p = 0.011) and significantly reduced opioid consumption in the first seven days postoperatively (a mean of 10 less MMEs per day; p < 0.001) compared with M-TKA. The RA-TKA group stopped taking opioids six days sooner (mean 24 days vs 30 days; p = 0.041). There were no significant differences in the number of days before stopping the use of walking aids (mean 31 days vs 35 days; p = 0.091). Patients in the RA-TKA group had significantly increased OKSs for the first five weeks (p = 0.013). There were no significant differences in the FJSs at all times or in OKSs beyond five weeks. There were no significant differences in the operating times (p = 0.405), step counts (p = 0.642), or complications (p = 0.222) between the groups. Conclusion:The use of robotic assistance in TKA led to significant improvements in pain, opioid consumption, and OKSs compared with manual instrumentation in the early recovery after primary TKA.

Background: Implant malalignment may predispose patients to implant failure or pain following total knee arthroplasty (TKA). Previous studies indicate that robotically-assisted total knee arthroplasty (RA-TKA) can achieve coronal alignment targets more accurately and precisely than manually instrumented total knee arthroplasty (M-TKA). The purpose of this study was to evaluate the accuracy of RA-TKA versus M-TKA in achieving predetermined coronal and sagittal alignment targets in TKA. Methods: A total of 201 RA-TKAs performed by three high-volume, fellowship-trained surgeons between June 2021 and June 2022 were compared to a historical control of 365 M-TKAs performed between 2013 and 2017 by the same surgeons. Coronal and sagittal component alignments were assessed using standing antero-posterior and lateral radiographs. Included measurements were femoro-tibial angle (FTA), medial distal femoral angle, proximal tibial angle, femoral sagittal angle, tibial sagittal angle, anterior condylar offset, and posterior condylar offset ratio. Normal and outlier ranges were determined from prior studies. The proportions of outliers were compared using univariate analyses. Results: The RA-TKA was more accurate than M-TKA in achieving all four sagittal alignment targets and two of the three coronal alignment targets. The RA-TKA group exhibited fewer radiographic outliers for distal femoral angle (zero versus 2.5%; P = 0.03), proximal tibial angle (one versus 10.1%; P < 0.001), femoral sagittal angle (7.0 versus 15.6%; P < 0.01), tibial sagittal angle (5.0 versus 14.3%; P < 0.01), anterior condylar offset (8.5 versus 30.6%; P < 0.01), and posterior condylar offset ratio (1.5 versus 9.5%; P < 0.01). Patients in the RA-TKA group had a higher proportion with no radiographic outliers (58.2 versus 35.2%; P < 0.001) and a lower incidence of > two outliers (5.5 versus 25%; P < 0.001) compared to the M-TKA group. Conclusions: The RA-TKA is more effective than M-TKA in achieving coronal and sagittal alignment, potentially enhancing surgical outcomes. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Background: Acetabular cup position is fundamental to total hip arthroplasty (THA) and surface replacement arthroplasty (SRA). Even if initial cup placement is adequate, changes in spinopelvic relationships alter functional acetabular position over time. This can lead to late complications. The purpose of this study was to examine changes in pelvic tilt and acetabular position in patients with at least 10 years of follow-up after THA or SRA. Methods: A retrospective review was conducted of patients from one academic practice who underwent THA or SRA and had at least 10 years of follow-up. Pelvic ratio was measured and converted to pelvic tilt. Changes in pelvic tilt were compared from initial X-rays to final follow-up and between two subgroups based on age. Clinically meaningful changes in pelvic tilt and estimated acetabular position were calculated. Results: There were 200 patients included: 100 aged 45 to 50 years and 100 aged 55 to 60 years. Their mean age was 52 years, 111 were men, and the mean body mass index was 29.7 (range, 18.8 to 49.3). Pelvic tilt change over the 10-year period was -9.87 degrees (SD 10.22), P < 0.001. This corresponds to an increase in acetabular inclination of 1.97 degrees and anteversion of 7.90 degrees. There was meaningful change in 62.5% of patients' posterior tilt with functional change in version or inclination of > 5 degrees. The subgroup of patients aged 45 to 50 years had a larger change in pelvic tilt (-11.50 degrees, SD 9.04) than patients aged 55 to 60 years (-8.25 degrees, SD 11.01), P = 0.024. Conclusions: We observed increases in posterior tilt in patients 10 years following THA or SRA, resulting in functionally increased acetabular anteversion and inclination. Larger increases in posterior tilt were seen in the younger group, which has implications for initial cup placement in patients with normal spines.

BACKGROUND:While early generations of cementless total knee arthroplasty (TKA) had inferior outcomes compared to cemented TKA, modern cementless designs have offered excellent clinical results. The purpose of this study was to compare patient-reported outcome measures (PROMs) and early aseptic revision rates of a specific cementless TKA design featuring a two-pegged tibia to that of its cemented counterpart. METHODS:A retrospective case series of all cementless and cemented TKAs utilizing a single design performed at a single, high-volume academic center was performed. Institutional review board approval was obtained. All cases were performed between November 2018 and March 2022. A minimum one-year follow-up was required. Demographics, complications, and reoperation/revision data were collected. Oxford Knee Score and Forgotten Joint Score were collected at one-year follow-up. Radiographic review was performed for cementless TKAs that were revised or had PROMs < one SD ("poor performers") or had PROMs > one SD ("high performers") below or above the mean, respectively. RESULTS:There were 329 cementless and 349 cemented TKAs included. Mean follow-up was 1.9 and 2.6 years for cementless and cemented cohorts, respectively. There were no statistical PROM differences between the two cohorts. There was no statistical difference in aseptic revision rates between the cohorts (4.0% cementless versus 1.7% cemented, P = 0.078); however, there was a higher rate of tibial aseptic loosening in the cementless cohort (2.7% cementless versus 0% cemented, P = 0.002). The mean time to revision for aseptic tibial loosening was 17.6 months. There was no statistical difference in radiolucencies between "poor performers" and "high performers." CONCLUSIONS:When compared to its cemented counterpart, the cementless TKA that was reintroduced in 2018 had similar one-year PROMs but a higher rate of early tibial loosening (2.7 versus 0.0%, P = 0.002). LEVEL OF EVIDENCE:III.

Dislocation is a frequent early complication of total hip arthroplasty 1 (THA) and is associated with a higher mortality rate compared with THA patients who do not sustain a dislocation. 2 Dislocation is one of the most common causes for revision surgery after loosening and infection. 3 The incidence of dislocation after primary THA within the first 90 days is approximately 3%, while that of revisions is over 2 times higher, and 8%. 4 Most published studies are from high-volume medical centers, yet most hip replacements are done by surgeons who perform a lesser volume of hip arthroplasties. Because of evidence that dislocation rate may be associated with surgeon experience, the incidence of dislocation overall may be higher than is reported from large centers.

BackgroundSleep disturbances are common after total knee arthroplasty (TKA). Despite the rising popularity of wearables to track sleep, little evidence exists in the arthroplasty literature regarding their efficacy. We aimed to correlate validated wearable sleep metrics with patient-reported sleep quality following TKA.MethodsPatients undergoing primary TKA were consecutively enrolled. Patients used a wearable device preoperatively and 90 days postoperatively to track five previously-validated measures of sleep. Each month, they rated their sleep quality. Wearable sleep data was correlated with patient-reported sleep quality using a point biserial correlation test. Categorical data were compared using Chi-square tests. A total of 110 patients were included.ResultsPreoperatively, 20.8% of patients reported “fairly bad” or “very bad” sleep; this increased to 44.4% 30 days postoperatively, then decreased to 26.5% 60 days postoperatively, and to 20.2% 90 days postoperatively. At 30 days postoperatively, time in bed, time asleep, and minutes of rapid eye movement (REM) sleep weakly correlated with patient-reported sleep quality (correlations 0.356, 0.345, and 0.345, respectively; P < 0.001). Sleep quality did not correlate with any wearable metric collected 60 or 90 days postoperatively.ConclusionPatient-reported sleep quality following TKA initially worsened postoperatively, then improved to preoperative levels by 90 days. Time in bed, time asleep, and REM sleep minutes only weakly correlated with patient-reported sleep quality at 30 days; no other correlations were detected. Surgeons that utilize remote monitoring following TKA should be aware that surrogate measures generated from these devices may correlate weakly, if at all, with the patient-reported outcome of the parameter being studied.

Background Smartphone and wearable technologies offer innovative methods for monitoring postoperative recovery in total knee arthroplasty (TKA) patients. This review assessed the benefits of these technologies in postoperative care, focusing on (1) smartphone applications, (2) wearable devices, and (3) their combination. Methods A systematic search identified studies on smartphone applications and wearables for post-TKA monitoring. The review analyzed 2,119 studies, with 58 meeting criteria: 25 on applications, 25 on wearables, and 8 on both. Studies were rated with a methodology index as well as by levels of evidence. They were then analyzed by categorizing them by adherence and patient satisfaction, functional outcomes and pain scores, gait analyses and ranges of motion, and measurement and comparison tools. Results A review of 24 of 25 publications related to smartphone applications used for postoperative recovery in TKA showed the potential for improved patient's satisfaction, gait recovery, pain medication scheduling guidance with improved pain management, cost savings, and functional outcomes. Wearable technologies used in postoperative recovery demonstrated monitoring accuracy in 25 studies. These devices also showed effectiveness in gait and motion analysis. Other demonstrated benefits of the wearables were improved outcomes, return to function, cost reduction, and again, better management of pain due to patient interaction and guidance. Studies that combined applications and wearables demonstrated the individual findings with the addition of adherence, patient's satisfaction, and overall mobility improvement at 3 months. Conclusions Smartphone applications and wearables can enhance postoperative rehabilitation for TKA patients. Smartphone applications and wearables have been shown in randomized trials to be accurate, effective, and useful in the postoperative rehabilitation of TKA patients. A recurring theme in the review was improved adherence to care plans and medication schedules that ultimately result in improved functional outcomes. These technologies and the data that they generate offer direct patient benefits and the potential for future cost savings.

BACKGROUND:Remote monitoring rehabilitation programs are new technologies growing in popularity for patients undergoing lower extremity total joint arthroplasty. The purpose of this study was to assess the patients' perceptions of these technologies. METHODS:Patients who underwent total hip arthroplasty (THA), total knee arthroplasty arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA) from September 2020 to February 2022, and participated in a clinical study utilizing remote monitoring and an app-based rehabilitation program were given a questionnaire 3 months postoperatively to assess their perceptions of these technologies. There were 166 patients who completed the survey (42 THA; 106 TKA; 18 UKA). RESULTS:There were 92% of patients who found the technology easy to use. A majority of patients felt the technologies motivated them. The TKA/UKA patients felt more strongly that these technologies allowed the surgeon to monitor their recovery closely (81.9% versus 65.9%; P = .009). There were 85% of THA patients and 94.5% of TKA/UKA patients recommended these technologies. The THA patients felt more strongly that digital rehabilitation could completely replace in-person physical therapy compared to TKA/UKA patients (85.4% versus 41.3%; P < .001). A majority (83%) of patients recommended a combination of inpatient and technology-assisted rehabilitation (THA 90.2%; 84.4% TKA/UKA). CONCLUSION:The THA and TKA/UKA patients found remote monitoring rehabilitation easy to use, increased motivation, and recommend it to other patients undergoing lower extremity arthroplasty. They recommend a combination of technology and in-person rehabilitation postoperatively. The THA patients felt these technologies could replace in-person rehabilitation programs. LEVEL OF EVIDENCE:IV.

Background: We previously reported the 2-year results of a prospective randomized controlled trial of cementless versus cemented total knee arthroplasty (TKA) implants of the same design. The purpose of the present study was to provide concise results at intermediate-term follow-up. Methods: The original study included 141 TKAs (76 performed without cement and 65 performed with cement). Since then, 8 patients died and 4 withdrew. Of the remaining 129 patients, 127 (98%) were available for analysis. Survivorship analysis was performed; Oxford Knee, Knee Society, and Forgotten Joint Scores were calculated; and radiographs reviewed. Mean follow-up was 6 years. Results: The survivorship free of any revision was 100% in both groups. There were no differences between the groups in any patient-reported functional outcome measure (p = 0.2 to 0.5). However, a higher percentage of patients in the cementless TKA group were either extremely or very satisfied with their overall function (p = 0.01). Radiographically, there was no evidence of implant loosening in either group. Conclusions: At 6 years, there were no differences between cementless and cemented TKA implants of the same design in terms of survivorship, clinical, or radiographic outcomes. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Total knee arthroplasty continues to evolve. It is important to review some of the current controversies and hot topics in arthroplasty. Optimal knee alignment strategy is now just a matter of debate. Mechanical, kinematic, and functional alignment and the role of robotics in achieving optimum alignment are important topics, along with fixation and outpatient knee arthroplasty.

Background: The impact of tourniquet use on recovery after total knee arthroplasty (TKA) remains controversial. The purpose of this prospective, single blinded, randomized controlled trial was to investigate the effect of tourniquet use on early recovery after TKA using a smartphone app-based patient engagement platform (PEP) with a wrist-based activity monitor to obtain more robust data on early recovery. Methods: There were 107 patients undergoing primary TKA for osteoarthritis who were enrolled (54 tourniquet [TQ+]; 53 no tourniquet [TQ-]). All patients utilized a PEP and wrist-based activity sensor for 2 weeks preoperatively and 90 days postoperatively to collect Visual Analog Scale (VAS) pain scores and opioid consumption, as well as weekly Oxford Knee Score (OKS) and monthly Forgotten Joint Score (FJS). There was no difference in demographics between groups. Formal physical therapy assessments were performed preoperatively and 3 months postoperatively. Independent sample t-tests were used for continuous data and Chi-square and Fisher's exact tests were used for discrete data. Results: Tourniquet use did not have a statistically significant impact on daily VAS pain or opioid consumption during the first 30 days postoperatively (P > .05). Tourniquet use did not have a significant impact on OKS or FJS at 30 or 90 days postoperatively (P > .05), or on performance of formal physical therapy testing at 3 months postoperatively (P >.05). Conclusion: Using a digital technology to collect daily patient data, we found that tourniquet use has no clinically significant negative impact on pain and function in the first 90 days after primary TKA. (c) 2023 Elsevier Inc. All rights reserved.

CASE:An active 64-year-old patient presented with new-onset lateral knee pain 42 days after an uncomplicated medial unicompartmental knee arthroplasty (UKA). Magnetic resonance imaging and diagnostic injection of local anesthetic identified an avulsion fracture of the popliteus tendon as the source of discomfort. Repair of the tendon to its native footprint was performed with suture anchor fixation. The patient was pain-free and returned to work without restrictions at 12 weeks. CONCLUSION:We identify a unique cause of knee pain after UKA-avulsion of the popliteus tendon. Successful management of this condition included anatomic repair of the tendon with suture anchor fixation.

Introduction: Remote physiologic monitoring (RPM), or remote therapeutic monitoring (RTM), has grown exponentially for the management of chronic medical diseases in Medicare patients. More recently, the application of this technology has ventured into the orthopaedic arena, and more specifically, for total joint arthroplasty. Platforms to expedite this monitoring can provide continuous biodata feedback on digital biomarkers to patients and surgeons, which can potentially help improve and create novel patient-specific recovery pathways. Furthermore, various devices developed for this monitoring might help obviate the need for frequent emergency room visits, readmissions, and prolonged outpatient physical therapy sessions, as well as reduce complications and increase patient satisfaction scores after total joint arthroplasty surgery. However, while there are a number of potential benefits to technology for this type of care, its application following total knee arthroplasty has not been well-studied. Therefore, after an overview of the usage of RPM and RTM, the purpose of this study was to review the current literature regarding three common remote monitoring technologies: 1) smartphone apps; 2) wearables; and 3) combined smartphone apps and wearables. We also considered the potential financial implications of remote physiologic monitoring. Materials and Methods: A comprehensive search of the PubMed, Cochrane Library, MedLine, and Web of Science databases was performed. Three main subgroups of monitoring devices were included for analysis: smartphone apps, wearable devices, and combined wearable plus smartphone app platforms. Searches focused on remote physiologic monitoring, patient-specific advantages, financial advantages, billing and coding options, as well as overall efficacy of platforms. Results: The current review found smartphone apps, wearables, and combined smartphone app and wearable platform technologies to be advantageous in the postoperative period following total knee arthroplasty. The wearable components can provide highly accurate and reproducible data, which the user-friendly smartphone app can relay to the patient so they can easily understand their progress. Additionally, through the apps, patients can directly access their surgical team. By constantly collecting and evaluating range of motion and functional data, the surgical team can identify if the patient is appropriately progressing through treatment or if further intervention is warranted. Conclusion: The incorporation of the remote physiologic monitoring devices during the post-total knee arthroplasty period shows strong promise as a progress-tracking modality. Published benefits include reduced physical therapy visits, decreased pain scores and reliance on opioids, increased activity levels as assessed by step counts, increased ability to follow less well-performing patients, reduced readmissions, reduced in-person clinic visits, and decreased postoperative costs.

BackgroundAcetabular retention in revision total hip arthroplasty (THA) may be advantageous, yet long-term survival data is limited. Thus, we investigated long-term survivorship of retained acetabular components in revision THA with analysis of rerevision rate, instability risk, and clinical outcomes.MethodsWe reviewed 98 hips with polyethylene wear and/or osteolysis that were revised with retained acetabular components. Acetabular inclination and anteversion were measured from prerevision radiographs. A retrospective chart review was performed, collecting outcomes of interest including Harris hip score, instability events, and rerevision surgery. Kaplan-Meier analysis was used to calculate the risk of revision over time. Predictors of survival including acetabular component position were analyzed by multiple logistic regression.ResultsAverage follow-up was 13 years (range, 5-24). Survivorship rates at 5, 10, 15, and 20 years were 89.7%, 81.6%, 70.8%, and 63.8%, respectively. There was improvement in average Harris hip score (61 to 76, P < .0001). There was a 9% rate of dislocation, and 6 hips (6%) were rerevised for recurrent instability. Overall, there were 23 (23%) rerevisions at an average of 6.1 years with the most common reasons being instability (6%) and aseptic loosening (6%). Use of conventional polyethylene was the only identified independent predictor of rerevision (P = .025).ConclusionsRetention of a well-fixed acetabular component in revision THA provides acceptable long-term outcomes with a 15-year survivorship of 71%. Instability and aseptic loosening were the most common reasons for rerevision. Surgeons may consider retaining the acetabular component at revision surgery if the implant is well-fixed and well-positioned.