Smart Implantable Device-Enabled Remote Monitoring Reduces Rates of Manipulation Under Anesthesia Following Total Knee Arthroplasty

Background Total knee arthroplasty (TKA) is a highly successful procedure; however, postoperative joint stiffness remains a common complication, occasionally requiring manipulation under anesthesia (MUA). This retrospective study aimed to compare MUA incidence between patients who received smart implantable devices (SIDs) and those with traditional components following TKA. We hypothesized that the use of SIDs through remote monitoring would result in decreased MUA incidence when compared to traditional knee implants. Methods This study included 806 patients who underwent primary TKA by a high-volume surgeon between July 2023 and December 2024. Of these patients, 500 received traditional implants, while 306 received SIDs. A power analysis was performed to determine the required sample size. The analysis indicated that a minimum of 431 patients would be required per group. Patients were followed for at least 90 days postoperatively, and MUA incidence was recorded. The demographic data and the Knee Injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR) measures were analyzed. Results The incidence of MUA was 3.101% for traditional implant recipients and 0.971% for SID recipients (p<0.05). Traditional implant recipients were over three times more likely to require MUA. Conclusion The use of SIDs in this study demonstrated a significant reduction in MUA incidence following TKA. SID implantation with remote monitoring led to a threefold decrease in the rate of MUA. This study highlights the potential of SIDs to significantly reduce the rate of MUA through remote monitoring of several gait metrics, such as functional range of motion, cadence, and step count, supporting their integration into TKA care protocols.