Digital monitoring of weight-bearing improves success rates and reduces complications in lower extremity surgeries


Submitted: 13 October 2023
Accepted: 25 October 2023
Published: 14 November 2023
Abstract Views: 813
PDF: 166
HTML: 2
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

  • Babak Otoukesh Department of Orthopedics Surgery, Iran University of Medical Sciences, Tehran, Iran, Islamic Republic of.
  • Seyedeh Fariba Moshiri Babol University of Medical Sciences , Babol, Mazandaran Province, Iran, Islamic Republic of.
  • Behrad Jahangiri Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of.
  • Kamal Mehraban Jafarlou Orumieh University of Medical Sciences, Orumieh, Iran, Islamic Republic of.
  • Shayan Amiri Shohadaye Haftom-e-Tir Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran, Islamic Republic of.
  • Nadieh Baniasadi Non-Communicable Diseases Research Center, Bam University of Medical Sciences, Bam, Iran, Islamic Republic of.
  • Bahareh Heshmat Ghahderijani Zahedan University of Medical Sciences, Zahedan, Iran, Islamic Republic of.

The aim of this study is to develop a digital monitoring system to track weight and evaluate its impact on postoperative outcomes after lower extremity surgeries (LES). This parallel randomized controlled trial enrolled 266 patients who underwent LES (fracture or joint replacement) at our medical center between March 11, 2022, and January 10, 2023. Patients were randomly assigned to the intervention and control groups in a 1:1 ratio. The intervention group (n=116) used a cane and shoes equipped with a weight-bearing system after lower limb surgery, while the control group (n=116) used a simple cane and shoes without a weight-bearing system. The primary outcomes included callus formation, duration of union, and success rate of union in the two groups. The intervention group had a significantly higher rate of complete surgical success than the control group (93.9% vs. 79.3%, p=0.001). The intervention group also had a significantly lower risk of non-union than the control group (OR: 2.33, 95% CI: 1.14, 3.48, p=0.001). The mean duration of surgery until the time of union and the meantime of callus formation was significantly lower in the intervention group (p=0.01). The use of a digital monitoring system for weighing in LES significantly increased the success rate and reduced post-operative complications. Therefore, incorporating this system can enhance the rehabilitation process and prevent revision surgeries in patients with LES.


Christiano AV, Pean CA, Konda SR, Egol KA. Predictors of Patient Reported Pain After Lower Extremity Nonunion Surgery: The Nicotine Effect. Iowa Orthop J. 2016;36:53-58. PMID: 27528836 PMCID: PMC4910799

Yeganeh A, Moghtadaei M, Sobhani A, Abbasi M, Gorgani H, Otoukesh B, Amiri Sh. Four-Year Prospective Evaluation of Femoral Neck Fractures: Types and Complications. J. Res. Orthop. Sci. 2020; 7 (3) :129-134. URL: http://jros.iums.ac.ir/article-1-2124-en.html DOI: https://doi.org/10.32598/JROSJ.7.3.715.1

Hemmann P, Friederich M, Körner D, Klopfer T, Bahrs C. Changing epidemiology of lower extremity fractures in adults over a 15-year period – a National Hospital Discharge Registry study. BMC Musculoskeletal Disorders 2021;22(1):456. DOI: https://doi.org/10.1186/s12891-021-04291-9

Court-Brown CM, Clement ND, Duckworth AD, Aitken S, Biant LC, McQueen MM. The spectrum of fractures in the elderly. Bone Joint J 2014;96-b(3):366-72. DOI: https://doi.org/10.1302/0301-620X.96B3.33316

Rouleau DM, Place A, Bérubé M, Laflamme YG, Feldman D. Rehabilitation after lower limb injury: development of a predictive score (RALLI score). Can J Surg 2015;58(4):278-83. DOI: https://doi.org/10.1503/cjs.015014

Johnell O, Kanis JA. An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 2004;15(11):897-902. DOI: https://doi.org/10.1007/s00198-004-1627-0

Yeganeh A, Amiri S, Otoukesh B, Moghtadaei M, Sarreshtedari S, Daneshmand S, Mohseni P. Characteristic Features and Outcomes of Open Gunshot Fractures of Long-bones with Gustilo Grade 3: A Retrospective Study. Arch Bone Jt Surg. 2022 May;10(5):453-458. PMID: 35755797; PMCID: PMC9194713.

Miranda MA, Moon MS. Treatment strategy for nonunions and malunions. Surgical treatment of orthopaedic trauma 2007;1:77-100.

Antonova E, Le TK, Burge R, Mershon J. Tibia shaft fractures: costly burden of nonunions. BMC Musculoskelet Disord 2013;14:42. DOI: https://doi.org/10.1186/1471-2474-14-42

Tay WH, de Steiger R, Richardson M, Gruen R, Balogh ZJ. Health outcomes of delayed union and nonunion of femoral and tibial shaft fractures. Injury 2014;45(10):1653-8. DOI: https://doi.org/10.1016/j.injury.2014.06.025

Seo H, Lee GJ, Shon HC, Kong HH, Oh M, Cho H, Lee CJ. Factors Affecting Compliance With Weight-Bearing Restriction and the Amount of Weight-Bearing in the Elderly With Femur or Pelvic Fractures. Ann Rehabil Med. 2020 Apr;44(2):109-116. Epub 2020 Apr 29. PMID: 32392649; PMCID: PMC7214136. DOI: https://doi.org/10.5535/arm.2020.44.2.109

Kammerlander C, Pfeufer D, Lisitano LA, Mehaffey S, Böcker W, Neuerburg C. Inability of Older Adult Patients with Hip Fracture to Maintain Postoperative Weight-Bearing Restrictions. J Bone Joint Surg Am 2018;100(11):936-941. DOI: https://doi.org/10.2106/JBJS.17.01222

Kubiak EN, Beebe MJ, North K, Hitchcock R, Potter MQ. Early weight bearing after lower extremity fractures in adults. J Am Acad Orthop Surg. 2013;21(12):727-738. DOI: https://doi.org/10.5435/JAAOS-21-12-727

Nadrian H, Moghimi N, Nadrian E, Moradzadeh R, Bahmanpour K, Iranpour A, Bellamy N. Validity and reliability of the Persian versions of WOMAC Osteoarthritis Index and Lequesne Algofunctional Index. Clin Rheumatol. 2012 Jul;31(7):1097-102. Epub 2012 Apr 14. PMID: 22526476. DOI: https://doi.org/10.1007/s10067-012-1983-7

Ebrahimzadeh MH, Makhmalbaf H, Birjandinejad A, Keshtan FG, Hoseini HA, Mazloumi SM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in Persian Speaking Patients with Knee Osteoarthritis. Arch Bone Jt Surg. 2014 Mar;2(1):57-62. Epub 2014 Mar 15. PMID: 25207315; PMCID: PMC4151432.

Ottesen TD, McLynn RP, Galivanche AR, Bagi PS, Zogg CK, Rubin LE, Grauer JN. Increased complications in geriatric patients with a fracture of the hip whose postoperative weight-bearing is restricted: an analysis of 4918 patients. Bone Joint J. 2018 Oct;100-B(10):1377-1384. PMID: 30295535. DOI: https://doi.org/10.1302/0301-620X.100B10.BJJ-2018-0489.R1

Rath E, Sharfman ZT, Paret M, Amar E, Drexler M, Bonin N. Hip arthroscopy protocol: expert opinions on post-operative weight bearing and return to sports guidelines. J Hip Preserv Surg. 2017 Feb 23;4(1):60-66. PMID: 28630722; PMCID: PMC5467404. DOI: https://doi.org/10.1093/jhps/hnw045

Roberts KC, Brox WT. AAOS Clinical Practice Guideline: Management of Hip Fractures in the Elderly. J Am Acad Orthop Surg. 2015 Feb;23(2):138-40. Erratum in: J Am Acad Orthop Surg. 2015 Apr;23(4):266. PMID: 25624366. DOI: https://doi.org/10.5435/JAAOS-D-14-00433

Raaben M, Redzwan S, Augustine R, Blokhuis TJ. COMplex Fracture Orthopedic Rehabilitation (COMFORT) - Real-time visual biofeedback on weight bearing versus standard training methods in the treatment of proximal femur fractures in the elderly: study protocol for a multicenter randomized controlled trial. Trials. 2018 Apr 12;19(1):220. PMID: 29650034; PMCID: PMC5898035. DOI: https://doi.org/10.1186/s13063-018-2612-9

Stoller I, Babanin A, Baumgartner H, Schröter S, Ihle C, Döbele S. Feedback and Analysis System to Improve Partial Weight Bearing and Bone Healing Following Fractures and Osteotomies of the Lower Limb: Technical Note. Acta Chir Orthop Traumatol Cech. 2021;88(3):217-221. English. PMID: 34228618. DOI: https://doi.org/10.55095/achot2021/034

Hustedt JW, Blizzard DJ, Baumgaertner MR, Leslie MP, Grauer JN. Current advances in training orthopaedic patients to comply with partial weight-bearing instructions. Yale J Biol Med. 2012 Mar;85(1):119-25. Epub 2012 Mar 29. PMID: 22461750; PMCID: PMC3313526.

Raaben M, Holtslag HR, Leenen LPH, Augustine R, Blokhuis TJ. Real-time visual biofeedback during weight bearing improves therapy compliance in patients following lower extremity fractures. Gait Posture. 2018 Jan;59:206-210. Epub 2017 Oct 20. PMID: 29078134. DOI: https://doi.org/10.1016/j.gaitpost.2017.10.022

Otoukesh, B., Moshiri, S. F., Jahangiri, B., Jafarlou, K. M., Amiri, S., Baniasadi, N., & Heshmat Ghahderijani, B. (2023). Digital monitoring of weight-bearing improves success rates and reduces complications in lower extremity surgeries. European Journal of Translational Myology, 33(4). https://doi.org/10.4081/ejtm.2023.11974

Downloads

Download data is not yet available.

Citations