A Smartphone Application-Based Remote Rehabilitation System for Post-Total Knee Arthroplasty Rehabilitation: A Randomized Controlled Trial.

BACKGROUND: Remote rehabilitation after total knee arthroplasty has gradually gained popularity in recent years. This study aimed to determine whether smartphone application-based remote rehabilitation could outperform home-based rehabilitation and outpatient guidance in terms of 12-week outcomes following primary unilateral total knee arthroplasty. METHODS: Patients who underwent primary unilateral total knee arthroplasty were recruited and randomly divided into a telerehabilitation group and a control group. A total of 100 patients were examined, with 50 each assigned to the telerehabilitation and control groups. In the telerehabilitation group, a telerehabilitation application was installed on the smartphones of the participants to allow postdischarge guidance. The primary outcomes were knee range of motion (ROM) at 12 weeks postoperatively. Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index, Knee Society Score, The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Five Times Sit-to-Stand Test (5xSST), Single-Leg Stance Test (SLST), satisfaction, rehabilitation costs, complication rate, and 90-day readmission rate. All outcomes were collected at 2, 6, and 12 weeks after surgery. RESULTS: At 12 weeks postoperatively, the telerehabilitation patients significantly outperformed the controls in terms of knee ROM (124 ± 8.7 versus 119 ± 5.5 P = .01), SF-36 (physiological function) (61.5 ± 20.3 versus 45.5 ± 18.1 P = .000), SF-36 (role-physical) (49.3 ± 41.5 versus 27.7 ± 28.9 P = .012), SLST (13.0 ± 9.1 versus 9.1 ± 5.9 P = .026), and 5xSST (17.7 ± 4.3 versus 19.4 ± 3.5 P = .043). No significant differences were found between groups in the Western Ontario and McMaster Universities Osteoarthritis Index score, Knee Society Score, rehabilitation costs, 90-day readmission rate, or incidence of adverse events. CONCLUSION: Our study showed that smartphone app-based remote rehabilitation worked better than home-based rehabilitation with outpatient guidance in terms of short-term results in ROM, SLST, and 5xSST.

Leukocyte Esterase Strip Quantitative Detection Based on RGB Photometry is a Probable Method to Diagnose Periprosthetic Joint Infection: An Exploratory Study.

OBJECTIVE: Leucocyte esterase (LE) strip test is the most rapid, convenient, and cheap method to diagnose chronic periprosthesis joint infection (PJI). However, the determination of LE strip mainly relies on colorimetric method with strong subjectivity, which leads to low diagnostic accuracy. Therefore, we try to convert LE strip images into digital data through the RGB photometric system to achieve objective diagnosis. This method will greatly improve the accuracy of LE strip detection and diagnosis of PJI. METHODS: From January 2021 to September 2021, 46 patients with suspected PJI after total hip and knee arthroplasty underwent diagnostic joint puncture. After effective joint fluid samples were harvested, they were divided into original fluid and centrifuged fluid for LE strip detection. Real-time images of LE strip were taken at 90 s, 3 min, 5 min, 10 min, and 15 min after sampling, and their brightness (Y) was obtained after they were input into an RGB photometric system. Grouping was based on centrifugation, infection, and time points, and then the differences in brightness among groups were compared. The correlation between LE strip image brightness and WBC count was evaluated. Student t-test was used for the parametric data and chi-square test for qualitative data. Simple linear regression was utilized to analyze the correlation between brightness and WBC count in each group. RESULTS: Included were 19 cases of PJI and 27 Non-PJI subjects diagnosed against ICM2018 diagnostic criteria. The brightness was lower in the PJI group than in Non-PJI group (p < 0.05). The brightness of the uncentrifuged group was lower than that of the centrifuged group (p < 0.05). Irrespective of centrifugation or infection, the brightness of LE strip decreased with the exposure time after sampling. The brightness of LE strip was correlated with WBC count at different time points, with the correlation being strongest 5 min after sampling (R2 (5 min) = 0.86, p < 0.0001). The correlation between LE strip brightness and WBC count was also found in the centrifugation group, with the correlation being most robust 15 min after sampling (R2 (15 min) = 0.73, p < 0.0001). CONCLUSION: A remarkable correlation was found between LE strip brightness and the WBC count. It is feasible to directly quantify LE strip image on a RGB photometer to achieve quantitative detection of LE strip to diagnose PJI.