Hoosiers Help Test Apple Watch For Joint Replacement Recovery

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The Apple Watch will track time spent sitting or standing, number of steps and even heartrate. The Apple Watch will track time spent sitting or standing, number of steps and even heartrate.

The Apple Watch is no longer just a fitness tracker—a new app developed by Warsaw-based Zimmer Biomet Holdings, Inc. is like “a live-in physical therapist,” says one Hoosier orthopedic surgeon. Zimmer Biomet’s mymobility app, developed in partnership with Apple Inc., is designed for patients and surgical care teams involved in hip and knee replacements, two of the most common surgeries in the U.S. Could tracking steps, activity and heart rate—among many other pieces of data—revolutionize patient recovery? One of the biggest enrollment studies in the history of orthopedic research aims to find out.

Indianapolis-based Midwest Center for Joint Replacement (MCJR) is the first center in the nation to enroll patients in the study and the only Indiana clinic to take part. Launched just a few weeks ago, the mymobility clinical study is examining the app’s impact on patient outcomes and overall costs for joint replacement. A dozen Hoosier patients undergoing joint replacement surgery are currently enrolled and wearing an Apple Watch as part of their pre-operative and post-operative care; the clinic aims to enroll hundreds more in the three-year study.

About 30 days prior to surgery, patients—up to 5,000 nationwide—are given an Apple Watch and use the mymobility app to prepare for their surgery; alerts are delivered directly to their wrist to remind them to complete tasks such as pre-op exercises, adjust medications or prepare their home for the recovery process.

Developers and surgeons believe the app’s greatest value will be realized in the post-op timeframe. The watch, working in tandem with the app, replaces traditional physical therapy visits. The new tool will track factors such as how much time the patient spends sitting or standing, how many steps he or she takes, the number of stairs climbed and even heartrate. The watch reminds patients to do their daily exercises and displays video demonstrations.

The patient’s movement and data are tracked and shared in real-time with his or her surgical team on an electronic dashboard.

“We can look down a whole list of patients [with the app]; the outliers are who we’re looking for,” says MCJR Orthopedic Surgeon Dr. Wesley Lackey. “90-plus percent of patients do great and have zero problems, but that small subset that may struggle with their therapy or may have a wound complication or may get sick after surgery—it pops up on our radar sooner. It’s better for us and the patient to stay more connected.”

Zimmer Biomet believes that connectivity is increasingly important with the growing emphasis on outpatient joint replacement; healthy patients, for example, can return home less than 24 hours after hip replacement surgery. Additionally, if a patient is concerned about the surgical incision, for example, he or she can securely send clinic staff a picture of it within the app. The orthopedic giant has created other apps, but Zimmer Biomet Vice President of Connected Health Strategy Ted Spooner says this is the first to collect patient data and deliver it to a care team.

“[Traditionally], once that patient goes home, the window of visibility to what the patient’s doing really closes to the care team. Combined with patient education pre-op, and the actual mobility tracking post- op, [the app] delivers a view of patient health that just wasn’t possible before,” says Spooner. “Tracking how long a patient is sitting, for example—that’s a pretty important factor to track, because of blood clots and the risk associated with immobility in the post-op setting.”

In addition to newfound accountability for patients, the watch data collected in the study will be groundbreaking, says Lackey.  

“When we have a pool of 5,000 watch-wearers for multiple years around joint replacement, we can look back at the data and see, when the heartrate goes up, it should trigger us to know this patient may be at risk for a complication—whether it’s blood clots, infection, pneumonia or some other thing,” says Lackey. “We’re interested to see if what we used to think is important—like measuring how many degrees the knee bends—is less important than knowing how active the patients is post-op.”

The study could potentially enroll 10,000 patients in the U.S.; half will use the app and watch, and the other half will follow traditional pre-op and post-op procedures with physical therapists.

Zimmer Biomet believes the app could “change the patient journey”—and pending the study results—perhaps even alter the standard of care for the more than one million patients each year who undergo knee and hip replacement.

Spooner says it “was natural” for Apple to work with Zimmer Biomet in the tech company’s effort to move the Apple Watch from a general fitness tool to a solution for health issues related to mobility.
Spooner says Zimmer Biomet expects the app will motivate patients to be more invested in their own recovery.
Lackey says working with the team at Apple was an “incredible” experience.
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