JOA - 2026-08-12 - Journal Article
Smart Implantable Device Use is Associated with Decreased Post-Discharge Hospital Utilization in Total Knee Arthroplasty Patients Who Have Metabolic Syndrome: A Propensity Score-Matched Analysis.
Nakla A, Aubin PM, Ademisoye S, Burr RG, Rajaee SS, Wu M
Topics
Key Takeaway
In metabolic syndrome TKA patients, smart implantable device use reduced 90-day hospital readmission from 11.1% to 5.6% and ED visits from 16.6% to 9.9%.
Summary Depth
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Summary
This study asked whether smart implantable devices (SIDs) reduce post-discharge hospital utilization in metabolic syndrome TKA patients using commercial claims data with propensity-score matching. SID patients had significantly lower 90-day ED visit rates (9.9% vs 16.6%, P=0.036), readmission rates (5.6% vs 11.1%, P=0.045), and medical complication rates (10% vs 23%, P=0.0001). The association persisted after propensity-score matching on metabolic syndrome severity components.
Key Limitation
The claims database cannot confirm whether SID remote monitoring data was acted upon clinically, making it impossible to attribute the outcome difference to the device itself versus unmeasured selection bias toward more engaged or better-resourced patients.
Original Abstract
BACKGROUND
Studies have demonstrated an increased risk of postoperative complications in patients who have metabolic syndrome undergoing total knee arthroplasty (TKA). Smart implantable devices (SIDs) and remote monitoring have shown promise in improving outcomes. The purpose of this study was to evaluate whether patients who have metabolic syndrome and a SID TKA had decreased post-discharge hospital utilization.
METHODS
This was a retrospective cohort study using data from a de-identified longitudinal commercial claims aggregator. All patients were diagnosed with metabolic syndrome, defined as diabetes mellitus type II plus at least two of the following: body mass index greater than 30, hypertension, or hyperlipidemia. There were 142 TKAs in 134 patients who had metabolic syndrome and received a SID, who were propensity-score-matched to 1,420 TKAs in 1,247 patients who had metabolic syndrome, but did not have a SID. The matched dataset was analyzed to compare emergency department (ED) visits, hospital readmissions, and reasons for unplanned acute postoperative care.
RESULTS
Of the 1,562 TKAs that were performed, there were 250 (16.0%) ED visits and 165 (10.6%) readmissions within the first 90 days postoperatively. The cumulative incidence of ED visits was 9.9% in the SID group compared to 16.6% in controls (P = 0.036). Hospital readmissions were significantly lower in the SID group (5.6%) compared to controls (11.1%), P = 0.045. Patients who did not have a SID had a higher rate of medical complications (23%) compared to those who had a SID (10%), P = 0.0001.
CONCLUSION
In patients who have metabolic syndrome undergoing primary TKA, the use of a SID was associated with significantly decreased post-discharge hospital utilization. Further work is needed to determine the mechanism by which smart implants may improve outcomes and reduce complications in high-risk populations.