Presented by OrthoEvidence

Good Morning. Summer is on the way. So is the burnout – orthopaedic trauma surgeons typically face significantly higher volume during the summer, which correlates with sleepiness. Patient safety events were also significantly higher in the summer. Finding ways to mitigate the effect of increased workload on resident burnout and sleepiness could minimize the risk to patient safety.

In today's edition:

🦵🏼 AR rehabilitation after total knee arthroplasty

📱 Reducing post-op pain with digital technology packages

🏋️‍♂️ Subscapularis-specific rehab after shoulder arthroplasty

Patient recovery after TKA hinges on an effective rehabilitation program. With the advent of augmented reality platforms, new ways of delivering post-operative rehabilitation are arising, which could change the patient experience in novel and exciting ways. But are they effective? This RCT aimed to assess the effectiveness of an AR-based digital healthcare system used after TKA. 

56 patients undergoing a TKA were randomized to receive an AR-based home exercise program (n=28) or conventional, brochure-based home exercise (n=28). The primary outcome of interest was the change in 4-meter gait speed up to 24 weeks follow-up. Secondary outcomes included functional, pain and quality of life measures.

• Both groups reported similar changes in 4-meter gait speed (p=0.438).

• No significant differences were observed between the AR-based group and the conventional group in functional outcomes, pain scores, quality of life scores, muscle strength, range of motion, or balance. All outcomes significantly improved over time in both groups.

Bottom line. AR-based rehabilitation resulted in significant improvements in clinical outcomes for patients recovering from total knee arthroplasty, comparable to that of conventional rehabilitation programs.

Read the full ACE Report on this study here.

The world is going digital. And it’s changing rehabilitation programs forever – telerehabilitation, applications, and biofeedback devices are some of the many ways that digital rehabilitation is changing the game. Could combining multiple digital rehabilitation strategies result in significantly improved outcomes for patients recovering from total knee arthroplasty?

102 patients undergoing a total knee arthroplasty were randomized to receive a digital technology package consisting of an exercise app, fitness tracker, and online health coaching in addition to usual care (n=51), or usual care only (n=51). The primary outcome of interest was pain intensity.

• Patients in the digital package group reported lower pain levels than the usual care group, however, this difference was not clinically or statistically significant (p=0.06).

• Patients who received the digital package reported significantly greater reduction in pain intensity, pain disability, sedentary behaviour compared to the control groups.

Bottom line. With TKAs rising every year, digital rehabilitation programs could help optimize the recovery process. However, pain improvements were not clinically relevant, and more research is needed to discern the value and appropriateness of such strategies.

Read the full ACE Report on this RCT here.

For end-stage glenohumeral osteoarthritis, total shoulder arthroplasty (TSA) is an established, effective treatment. Subscapularis tendon healing is critical after TSA, contributing to shoulder stability. However, most rehabilitation programs don’t include exercises targeting this critical muscle. It was of interest to explore whether a subscapularis-specific rehabilitation physical therapy regimen could improve muscle strength and range of motion after TSA.

71 patients undergoing TSA were randomized to receive either traditional rehabilitation (n=35) or subscapularis rehabilitation (n=36), consisting of traditional rehabilitation with additional subscapularis exercises. The primary outcome of interest was subscapularis strength. 

• For subscapularis strength, there were no significant differences between groups up to 12 months post-operation.

• Range of motion and patient-reported outcome measures were similar between the two groups. However, PROMIS-upper extremity scores were significantly better in the traditional group at 12 months post-operation.

Bottom line. Adding subscapularis-specific exercises did not result in any meaningful improvement in subscapularis muscle strength or patient-reported outcomes for patients recovering from TSA.

Read the full ACE Report on this trial here.

Osteoarthritis: A Look at the Literature – In this OE Original, we scanned the current literature on osteoarthritis to find out the most prominent treatments, ongoing trials, and key market players in the field. (Read)

Sliding Hip Screws vs. Cancellous Screws – Published in the Lancet back in 2017, this large RCT randomized 1,108 patients with hip fractures to receive either sliding hip screws or cancellous screws. Results were interesting – no differences were observed in reoperation, but the rate of avascular necrosis was higher in the sliding hip screw group. (Read)

The Importance of Broad General Knowledge – In this OrthoJoe podcast, Dr’s Marc Swiontkowski and Mohit Bhandari sit down to discuss the importance to the orthopaedic surgeon – young or old – of having a large general knowledge base in the field. (Read)

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