gms | German Medical Science

Objectives: In forthcoming decades, there is expected to be a significant increase in the incidence of total hip arthroplasty (THA). In addition to the actual surgical procedure, the post-operative and long-term follow-up treatment is also crucial for the joint replacement's success. There is already an attempt to get patients more involved in the procedures before and after the surgery (Care4Today) and to implement new technologies (e.g. Apps)

Assessment of patients' well-being or postoperative progress is often highly subjective - so far, objective feedback has hardly been possible. With the help of an activity tracker, we wanted to study the post-operative phase. How mobile are our patients? Are there age or gender-specific differences? Are the patients interested in new technologies?

Methods: As part of a prospective study, the post-operative mobilization was recorded and analyzed by activity-trackers (Fitbit-bracelets) between 05/2016 and 08/2017 in 100 patients who received a THA. 50 men (70.6y) and 50 women (71.1y) were included. The activities were measured from the first post-operative day until midnight before the day of discharge. Pre-operative, the Harris Hip Score (HHS) was recorded. Furthermore, the patients were interviewed for their acceptance of the device.

Results and conclusion: The average hospital stay was 7.9 days. The number of steps on the first postoperative day was 712. On average 1,528 steps were completed daily. One day before discharge, the average number of steps was 2,165. There were no gender differences in age and pre-operative HHS (m 55.3 vs. f 53.9). Also, there were no differences in the number of steps on the first day (m 745 vs. f 678). A statistically significant result can be found in the number of steps prior to discharge: on this day, men performed 2,483 and women 1,846 steps (p=0.04). With a p-value of 0.06, the difference in average number of steps per day between the gender (m 1734 vs. f 1322) was barely not-significant.

42% of patients own a smartphone (average age 66.2y). Patients without a smartphone were, on average, 8 years older. 52% of the patients found the activity tracker to be motivating and 65% were open to new technologies in the hospital. 14% did not check at all or only queried their wristband data once a day, 65% queried 2-4 times/day, and 21% retrieved the data > 5 times/day.

Since reference values are largely missing, it is difficult to interpret the (absolute) measured steps (Toogood et al., Twiggs et al.). Overall, the male patients showed greater activity with a greater number of completed steps. A majority of patients are familiar with and/or interested in new technologies. For example, 86% called up the data numerous times a day on their own and more than half of the patients perceived the bracelet as a motivator.

In addition to the patient's use, the attending physician could also make use of the collected data. The post-operative rehabilitation could be monitored regularly and corrections are possible at an early stage.