Evaluating Knee Recovery Beyond Patient Reports: A Comparative Study of Smart Implantable Device-Derived Gait Metrics Versus Patient-Reported Outcome Measures in Total Knee Arthroplasty.

BACKGROUND

Total Knee Arthroplasty (TKA) is frequently performed for advanced osteoarthritis, with patient-reported-outcome measures (PROMs) traditionally reporting on efficacy. These subjective evaluations, although useful, may inaccurately reflect post-TKA activity levels. With technological advancements, smart-implantable devices (SID) offer objective, real-time gait metrics, potentially providing a more accurate postoperative recovery assessment. This study compares these objective metrics with PROMs to evaluate TKA success more effectively.

METHODS

We conducted a retrospective cohort study with 88 participants undergoing TKA using a SID. Eligible patients were aged 18 years or older and had advanced osteoarthritis. We excluded those who had bilateral TKAs, joint infections, or neuromuscular disease. The SID system collected daily gait metrics, including step count, distance traveled, walking speed, stride length, cadence, and functional knee range of motion (ROM). The PROMs, including Knee-Injury-and-Osteoarthritis-Outcome-Score-Joint-Replacement (KOOS-JR), Veterans-Rand-12-Physical-Component-Summary (VR-12-PCS), and Veterans-Rand-12-Mental-Component-Summary (VR-12-MCS), were analyzed against SID gait metrics. Among the 88 patients, 80 provided continuous data over 12 weeks.

RESULTS

All gait metrics, except stride length, significantly increased at the 12-week point (P < 0.05). The PROMs also significantly improved postoperatively (P < 0.05). Initial low positive correlations between 12-week PROMs and SID metrics decreased after adjusting for demographic variables, leaving only weak correlations between VR-12-PCS and KOOS-JR with functional-knee-ROM (r = 0.389, P = 0.002; r = 0.311, P = 0.014, respectively), and VR-12-MCS with step-count (r = 0.406, P = 0.001) and distance-traveled (r = 0.376, P = 0.003).

CONCLUSION

This study indicates that both PROMs and SID gait metrics show significant improvements post-TKA, though they correlate weakly with each other, suggesting a possible discrepancy between perceived recovery and actual functional improvement. The SID gait metrics might provide a valuable addition to traditional PROMs by offering an objective representation of physical capabilities unaffected by patient compliance or subjective perceptions of recovery. Further research is needed to validate these findings in larger populations and to explore whether integrating SID metrics can enhance long-term functional outcomes.

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