Your knee can’t send a text message (yet), but there’s a new technology that’s allowing replaced knees to pass along the right messages to health care teams about how a patient’s recovery is going.
As the pandemic has the health care sector embracing remote tools … and as the tech sector has devices moving toward “smart” everything … a new, implantable “smart knee” innovation is capitalizing on some of the latest trends.
And a local health care institution is capitalizing on it.
Holy Name last year announced it would become one of the first facilities regionally to adopt Persona IQ, a first-ever “smart knee” technology that can be implanted during a total knee replacement. Dr. Dennis Pfisterer, Holy Name’s orthopedic administrator and clinical director for sports health services, said it’s catapulting forward the medical center’s ability to monitor its patients after surgeries.
The devices provide medical teams information that they use to tweak and customize after-surgery care. Pfisterer said those data points can be charted and put on what doctors refer to as the “recovery curve,” which tracks how well one patient is doing versus peers.
Here’s a big reason he calls the new technology potentially revolutionary for his field: The recovery-tailoring benefit from that is only going to improve over time.
“As anyone who knows about data will say: The data is only as good as the data you put in,” he said. “These measures being collected will only get more helpful as the ‘n’ gets larger. So, the goal is to get as many implanted as possible.”
As far as how well it’s catching on, the amount of patients being outfitted with these implants is growing rapidly in New Jersey, Pfisterer said. But, with the technology just being introduced to the U.S. last year, and with Holy Name announcing its debut in December, it’s still very much in its infancy.
And the first demand on its wider adoption is a basic one: People have to learn what it is.
“When we talk about putting this in, it’s often the first time those patients have heard anything about it,” he said. “No one is coming in asking about it right now.”
Not only was this device the first and only smart knee implant to clear the U.S. Food and Drug Administration’s novel medical device process, it’s really the first implantable device for remote monitoring of post-surgery data in general. Teaneck’s Holy Name is one of the sole hospitals in the Garden State implanting these devices.
Although there’s a significant cost associated with the adoption of a new technology such as this by health care facilities, the consensus was that the traditional method of evaluating post-surgery patients needed improving. Patients would get back into an office setting, medical staff would watch them walk and then come to a subjective judgment about their recovery progress, Pfisterer explained.
With this technology, staff — and patients themselves, through an app where data is transmitted through a router in the patient’s home — can record FitBit-like information, including the number of steps a patient takes throughout a day. But the device also provides minute details important to doctors, including stride length and the knee’s exact range of motion.
Equally important? The data that’s not collected.
One of the other limitations in having this more enthusiastically embraced by patients is the fear of the technological unknown. Pfisterer said those concerns take the form of questions about whether someone might be able to track them, or know what they’re doing at all times.
“We can help them rest assured that’s not happening,” he said. “There’s no GPS tracker, nothing obtainable about their location from that standpoint. It’s only certain measurements … that can be obtained by surgeons and doctors to help rehab and overall outcomes.”
The addition of this implant in a knee replacement surgery also isn’t going to make knee replacements increasingly complicated, Pfisterer implied. The smart device, which is powered by a small battery that lasts 20 years, attaches to the tibia bone during what’s essentially the same knee replacement surgery. There’s no knowing it’s there afterward, outside of an X-ray.
The first patients to elect to have the implant put in at Holy Name came to the conclusion that they’d benefit from the team tasked with their care being able to respond more quickly, and with more accuracy, in their post-surgery recovery period.
“If I can use a tool that’s going to help me as a surgeon make their knee replacement better, or make rehab and recovery outcome overall better, they’re excited about that concept,” Pfisterer said.
There’s a potential long-term benefit, as well, he added. When patients between five to 10 years down the road experience clinical struggles, Pfisterer said that, often, patients haven’t been monitored too closely past their first years following knee surgery. Having these smart devices still collecting data during that time helps doctors address that recurring discomfort.
The way this data can fill in the gaps is something Pfisterer expects won’t end up just being revolutionary for knee replacement patients.
He anticipates a smart device revolution across the larger orthopedic world.
“There’s already research & development looking at where we can put this smart device on the hip to give similar data points,” he said. “That’s not available yet, but that’s on the horizon. It’s something we’re likely going to see in the next couple of years. So that’ll be encouraging as well.”
Treating sleep apnea
As the medical advertisements on television gently urge: Ask your doctor if the latest sleep apnea treatment might be right for you.
Seriously, Dr. Kianoush Sheykholeslami of Saint Peter’s University Hospital, might say: Ask.
Because, as Sheykholeslami, chief of ear, nose and throat and head and neck surgery, observes, obstructive sleep apnea is still one of the most underdiagnosed and undertreated problems in health care. And there’s a new device his team is surgically implanting that can reduce or, in some cases, cure a disorder that affects some 22 million of the country’s residents.
The FDA-approved Inspire Sleep Therapy, which does feature regularly today in television advertisements, is an implantable upper airway stimulation device that’s described as monitoring breathing patterns during sleep and stabilizing a patient’s airway muscles to prevent obstruction.
The traditional treatment for sleep apnea is a machine called a CPAP, or continuous positive airway pressure therapy.
“This treatment has been in use for a half-century,” Sheykholeslami said. “The problem with this treatment (is) that it’s really uncomfortable for the patient. It’s cumbersome.”
Hence why up to half of patients stop using them, he added.
The challenges to a wider embrace of the new Inspire alternative, which does require general anesthesia and often a one-night stay in the hospital, is that there’s a limited criteria that makes patients candidates for it: Patients can’t be significantly obese, must have moderate to severe obstructive sleep apnea and cannot benefit from CPAP devices.
Sheykholeslami added that there also needs to be more education about this new innovation for sleep apnea sufferers. Primary care doctors, for example, are still very hesitant to refer patients that could potentially benefit from it.
“The way we look at it, the amount of pain or discomfort from the procedure, which is well-tolerated, is not comparable to the damage of sleep apnea, which can lead to hypertension and many other long-term health risks,” Sheykholeslami said.
