JOA - 2026-05-01 - Journal Article; Systematic Review; Meta-Analysis
Efficacy of Lower-Limb Wearables to Assess Recovery Following Total Hip or Knee Arthroplasty: A Systematic Review and Meta-Analysis.
Garabedian M, Legler J, Benzouak T, Baskaran S, Mutch J, Albers A
Topics
Key Takeaway
Lower-limb wearables detected significant improvements in Oxford Hip Score (p<0.001), Oxford Knee Score (p=0.020), and UCLA Activity Index (p<0.001) post-arthroplasty, but daily step counts did not significantly increase until beyond six months postoperatively.
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Summary
This systematic review and meta-analysis evaluated lower-limb wearable sensors for objective postoperative monitoring in THA and TKA patients across 10 studies identified from 532 screened articles. Wearable-captured PROMs improved significantly at 3, 6, and 12 months, but objective step count data showed no significant change within the first six months despite patient-reported gains. TKA and THA demonstrated comparable step count improvements at final follow-up but distinct recovery trajectories, suggesting procedure-specific rehabilitation benchmarks may be warranted.
Key Limitation
The total patient sample size across all 10 included studies is not reported, making it impossible to assess the statistical power or precision of the pooled effect estimates.
Original Abstract
BACKGROUND
The purpose of this review was to assess the use of lower-limb wearable sensors in monitoring total hip arthroplasty (THA) or total knee arthroplasty (TKA) recovery. Outpatient postoperative assessment routinely focuses on patient-reported outcome measures, which can be limited by ceiling effects and subjective reporting. Wearable sensors provide objective, real-time, remote data, enabling recovery tracking, rehabilitation protocol adjustments, and patient exercise adherence. Lower-limb sensors are particularly useful, as close proximity allows monitoring of clinical outcomes specific to the affected joint.
METHODS
Embase, PubMed, Scopus, and Web of Science were searched to identify studies on monitoring following arthroplasty. Included articles employed lower-limb wearable devices for continuous, at-home, postoperative monitoring within 18 months of surgery in patients who underwent THA or TKA. Outcomes of interest included patient-reported outcome measures and objective physical activity. Of 532 screened articles, 10 were included; five investigated TKA patients, while five focused on THA. Objective metrics included step counts (n = eight) and range of motion (n = four).
RESULTS
Postoperative outcomes showed significant improvements in the Oxford Hip Score (P < 0.001), Oxford Knee Score (P = 0.020), and University of California, Los Angeles Activity Index (P < 0.001) at three, six, and 12 months postoperatively, respectively. While no significant change in daily steps was noted within six months postoperatively, it significantly increased at the final follow-up, within one year of surgery, with TKA and THA patients demonstrating comparable improvements.
CONCLUSIONS
The integration of lower-limb wearables into postoperative care for TKA and THA presents an innovative approach to monitoring recovery. Findings from this analysis show differences between TKA and THA, suggesting a unique trajectory for each surgery. Continuous, objective data may help assess patient progress, identify atypical recovery patterns at earlier time points, and individualize rehabilitation strategies. This data tracking may allow for earlier clinical interventions, particularly in underserved regions.