Enhancing recovery after outpatient joint replacement via remote monitoring technology: a pilot study

Vibav Mouli, MS
Department of Orthopedics
Poster Overview

The volume of knee and hip replacement procedures is rising rapidly. While most of these surgeries require a hospital stay, there is a trend towards early discharge for select patients, especially to reduce hospital costs. New clinical protocols and tools are needed to ensure high quality care even after leaving the hospital. In this pilot study, we wanted to investigate if, after same-day discharge, patients are able to use remote monitoring technology and home coaching to enable safe recovery. We provided a blood pressure and heart rate monitor to patients on the day of surgery, and they were instructed to take three measurements the next morning at home. When the readings were similar and when patients experienced no negative symptoms (e.g., dizziness, nausea, lightheadedness), they were cleared to get out of bed (“ambulate”) and start their daily activities. In this way, the protocol was designed to identify patients at higher risk for falls due to low blood pressure. 94.4% of patients discharged used the device successfully and rated their experience positively across ease of use (8.9/10), satisfaction with home coaching (9.7/10), and improvement in patient safety (8.4/10). These pilot results suggest value in implementing tele-monitoring for patients after joint replacement.

Scientific Abstract

Introduction: Digital health tools are increasingly utilized to monitor patients’ progress. The purpose of this pilot study is to assess adoption and value of a remote, wireless blood pressure (BP) and heart rate (HR) monitor after outpatient joint replacement. Methods: 25 patients undergoing elective knee or hip arthroplasty were given a BP/HR monitor in PACU, linked to a web-based clinical portal for real-time data capture. They were asked to take three readings (supine, seated, standing) at home the morning after surgery, observing for 20-point systolic drop, 10-point diastolic drop, 10-point HR increase, or hypotensive symptoms. If any criteria applied, patients were instructed to stay in bed, hydrate with 0.5L water, and re-measure until resolution. Results: 18 patients were discharged as planned, of which 94.4% (n=17) reported successful operation of the device. “Ease of use” was rated 8.9/10, satisfaction with home coaching was 9.7/10, and improvement in patient safety was 8.4/10. 27.8% of patients discharged (n=5) followed hydration protocol and delayed mobilization in response to BP aberrations or symptoms.

Conclusion: Our pilot findings suggest the feasibility and value of remote monitoring after same-day arthroplasty to identify patients requiring hydration prior to mobilization and support safer recovery

Clinical Implications
Our pilot found that there is high compliance and satisfaction with the use of remote monitoring technology after same-day joint replacement. This telemedicine approach to recovery demonstrates promise in improving surgical outcomes, while ensuring convenience and potentially decreasing costs.
Research Areas
Authors
Vibav H Mouli, MS; Natalie Schudrowitz, BS; Jean Flanagan Jay, PT; Vivek M Shah, MD
Principal Investigator
Wolfgang Fitz, MD

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