App- and wearable-supported recovery after arthroplasty: nurse-led conceptual vignette

Background: why prehabilitation and structured rehabilitation matter

Each year, thousands of patients undergo joint replacement, yet many struggle with preparation and rehabilitation once home. Recovery quality, however, depends not only on the surgery itself but also on what patients learn and do before and after the procedure: preparing physically and psychologically (often called prehabilitation), mobilising early and practising daily exercises. Guidance for primary joint replacement emphasises accessible information, early mobilisation and timely rehabilitation across the pathway, delivered by coordinated multidisciplinary teams [1]. In practice, anxiety, uncertainty about day-to-day tasks and fragmented transitions can blunt adherence once patients return home. As services expand day-case models and virtual wards, safe, practical home support becomes central to quality and safety [2].

Focused problem. Adherence is the linchpin between planned care and realised recovery. Interventions that translate complex plans into small, daily actions (and keep multidisciplinary teams connected) are more likely to produce consistent early function and confidence.

Digital innovation: what an app and wearables add

A single, lightweight application can turn complex instructions into achievable steps: ≤3-minute educational videos, daily checklists and prompts, plain-language scripts and secure in-app messaging. Wearable devices add continuous, objective information on vital signs and movement, creating a richer picture of recovery than intermittent checks.

Evidence signal. A 2024 meta-analysis reported that telerehabilitation after TKA was more effective than traditional face-to-face models on short-term functional outcomes [3]. A recent randomised trial found that a smartphone-app rehabilitation programme was superior to a home-based programme with outpatient guidance for early range-of-motion and functional tests [4]. Postoperative wearable monitoring is feasible and can support earlier recognition of deterioration, but accuracy, alert noise and adherence require local validation [5, 6, 7]. These signals justify implementation with proportionate safeguards (Fig. 1).

Figure 1

Figure 1

App- and wearable-supported pathway from prehabilitation to telerehabilitation, showing roles, data flows and escalation.

Mapping to guidance and policy

National guidance such as NICE NG157 emphasises the provision of clear information, timely rehabilitation and explicit routes to help before and after surgery [1]. In parallel, service models built around day-case pathways and virtual wards depend on well-defined escalation processes and reliable remote review capacity [2]. A nurse-led digital pathway operationalises these expectations at home: perioperative nurses coordinate education, monitoring and escalation; physiotherapists adjust programmes in response to progress; and surgeons and anaesthetists reinforce timelines and key safety messages.

Implementation blueprint (practical steps)

1) Co-design and accessibility. Co-create content with patients, perioperative nurses and physiotherapists. Prioritise clarity and accessibility: large fonts, high-contrast visuals, captions, plain-language scripts, language options and a carer mode. Sequence content to real-world stages (decision to operate; pre-assessment; day of surgery; first week at home).

2) Onboarding and support. Introduce the app during pre-assessment using teach-back; pair devices and provide a one-page quick-start guide and a helpline for the first fortnight after discharge. Offer a non-digital alternative (printed packs and scheduled telephone reviews) to protect equity.

3) Content stream mapped to the pathway. The content is sequenced across the perioperative pathway. During prehabilitation (four to six weeks before surgery), the app focuses on expectations, self-management, analgesia planning and progressive strength and range-of-motion tasks. In hospital over the first 0–48 hours, it supports day-by-day mobilisation targets, optimisation of analgesia, thromboprophylaxis cues and the basics of wound care. After discharge (two to eight weeks), it guides graded exercises, prompts self-monitoring and delivers red-flag education (covering fever, calf swelling, wound changes and breathlessness), while keeping clear routes to help, in line with guideline recommendations [1].

4) Devices and data. Data capture mirrors this clinical arc. A single-use patch records physiological signals for the first 7–14 days: heart rate, respiratory rate and oxygen saturation, with temperature as an option; while an activity tracker extends monitoring for up to eight weeks, logging step counts and simple functional tasks such as sit-to-stand or short walk tests, alongside brief patient-reported outcomes (for example, pain on movement and confidence). Nurses review dashboards on weekdays, with physiotherapists conducting weekly reviews or sooner if progress stalls; short video check-ins can be scheduled for patients who need additional coaching. Reviews caution that alert thresholds and decision logic should be validated locally to minimise false alarms and unnecessary escalation [5, 6, 7].

5) Escalation and safety net. Define combined thresholds (for example, persistent tachycardia plus high pain plus very low activity; or a drop in oxygen saturation with breathlessness) that trigger nurse contact and, if needed, clinic review or urgent assessment. Make ‘who to contact’ prominent in the app and printed materials.

6) Equity safeguards. Provide non-digital options, loan devices and carer proxy access. Monitor uptake and outcomes by age, language and deprivation index; and report equity metrics in routine audits.

7) Interoperability and documentation. When feasible, integrate with the electronic patient record; keep an auditable log of alerts, responses and outcomes.

Barriers and mitigations

Successful implementation of digital pathways depends on anticipating barriers at multiple levels. Ensuring equitable access and sustained engagement protects inclusion, while robust safety protocols and governance frameworks safeguard patients and providers. Equally, service readiness and organisational rehearsal are essential to prevent gaps in care. Integrating these mitigation strategies from the outset can enhance trust, resilience and sustainability of digital health interventions (Table 1).

What services can realistically expect

Services should anticipate earlier functional gains and greater patient confidence when bite-sized tasks are paired with timely coaching, supporting early range-of-motion goals and walking tolerance [3, 4]. Proactive reassurance and early troubleshooting can reduce ad hoc calls and unscheduled reviews, while continuous signals and explicit escalation rules make day-case expansion safer without compromising standards, in line with the virtual wards framework [2]. Routine analytics (such as adherence, step counts and Oxford Knee Score at six to eight weeks) create feedback loops for iterative improvement and local benchmarking.

Evidence from other surgical settings, such as bariatric surgery, supports the feasibility and safety of wearable-supported pathways, showing significant reductions in hospitalization days without increasing complications [10]. Similarly, an app-based knee trainer has demonstrated promising results in improving functional outcomes, such as KSS function score and VAS, after total knee arthroplasty [11].

Proportionate evaluation

Begin with a short feasibility phase of one to three months, focusing on onboarding success, adherence (percentage of days with tasks completed), notification open rates, usability (for example, the System Usability Scale), alert volume and nurse response times. If feasibility is acceptable, progress to a 12-month pre-/post-service evaluation using interrupted time series with statistical process control to track Oxford Knee Score at six to eight weeks, physiotherapy visits, unplanned contacts and length of stay, modelling autocorrelation and seasonality [3, 4]. When signals are positive, a pragmatic multicentre trial can then evaluate patient-reported outcomes, complications at 30 and 90 days, and cost–utility outcomes. Recent overviews of randomised studies on apps and wearables in arthroplasty offer useful endpoints and design cues [6, 7].

Research ethics statement

Not applicable to this article.

Consent for publication statement

Narrative articles are based on clinical vignettes and created to provide a framework for discussion and maximise learning. These are not based on real individual patients and do not describe discrete patient interactions or outcomes. The objective is to summarise an interesting topic in perioperative medicine in response to a specific clinical question posed by the authors.

Conflicts of interest

The authors declare no conflicts of interest with this article.