The purpose of this study is to evaluate the early outcomes with the use of a smartphone-based exercise and educational platform after primary total hip arthroplasty compared to a standard of care control group. A multicenter prospective randomized control trial was conducted evaluating the use of the mymobility smartphone-based care platform for primary total hip arthroplasty (THA). Patients randomized to the control group (198 patients) received the respective institution's standard of care. Those randomized to mymobility treatment group (167 patients) were provided an Apple Watch and mymobility smartphone application. The application provides pre and postoperative educational content, video directed exercise programs as well as tracks the patient's activity. Patients in the treatment group were not initially prescribed physical therapy, but could be if their surgeon deemed it necessary. Early outcomes assessed included 90-day hip range of motion, HOOS JR scores, 30-day single leg stance (SLS) and time up and go (TUG) test. We also evaluated PT utilization, THA complications associated with readmissions, ER visits not associated with readmissions, urgent care (non standard of care) visits, and physician office visits. Outcome scores include HOOS-Jr, EQ-5D-5L, single stance (SLS), Timed up and go (TUG). Satisfaction scores for the procedure and the mymobility study group were also recorded.Background
Methods
Total hip arthroplasty (THA) in the young patient has been associated with higher rates of revision and perioperative complications. For clinicians and patients alike, there remains a desire to better characterize the durability of THA in young patients. We reviewed secondary data from our institutional database for all patients who underwent primary THA from January 2000 to May 2015. Patients were identified using ICD-9 procedure code 81.51. Our primary interest was the survival of implants in patients 30 years of age or younger (n=167) while using a contemporaneous cohort of patients age 60 and older as a control (n=1359). Failure was defined as revision THA for any reason. Cox regression with robust standard errors was used to calculate hazard ratios. A population-averaged Poisson regression analysis was used to compare complication rates. The rate of all-cause revision THA was 2.4 times greater (95% CI 1.10 – 5.37, p=0.028) in young patients (7%, 12/167) undergoing primary or conversion to THA compared to their elderly counterparts (3.7%, 50/1,359). Survival at 10 years was 89% (95% CI 82 – 94) in the young cohort and 96% (94 – 97) in the elderly cohort. The primary reasons for revision in young that patients compared to their elderly counterparts included metal-on-metal implants (IRR 8.12, 95% CI 2.04 – 32.38, p=0.003). These data demonstrate that patients 30 years of age and younger substantially benefit from THA but should be warned of higher risk of subsequent revision.
