Quantifiable ankle pump exercise monitoring for early postoperative rehabilitation after hip and knee arthroplasty: an exploratory randomized controlled trial

Background Deep vein thrombosis (DVT) remains a clinically important complication after hip and knee arthroplasty. Although ankle pump exercise (APE) is widely recommended to promote venous return, adherence is often suboptimal. Quantifiable monitoring may improve exercise delivery, but its clinical value remains uncertain. Objective To evaluate quantifiable APE monitoring for postoperative exercise adherence, DVT incidence, venous hemodynamics, and rehabilitation-related outcomes after hip or knee arthroplasty. Methods This prospective, single-center, open-label exploratory randomized controlled trial enrolled 100 patients undergoing hip or knee arthroplasty between July and November 2023. Patients were randomized 1:1 to an experimental group receiving wearable sensor-based APE monitoring with a mobile application and real-time data transmission or a control group receiving conventional APE education and routine reminders. The registered co-primary outcomes were exercise adherence on postoperative day 7 and DVT incidence by postoperative day 14. Secondary outcomes included venous hemodynamic parameters and patient-reported outcomes, including self-efficacy assessed using the General Self-Efficacy Scale (GSES), perceived exertion assessed using the Rating of Perceived Exertion (RPE), pain assessed using the Visual Analog Scale (VAS), and patient satisfaction. Results Exercise adherence (86% vs. 64%; absolute difference, 22.0 percentage points; 95% CI, 5.6 to 38.4; P = 0.011) and patient satisfaction (94% vs. 78%; absolute difference, 16.0 percentage points; 95% CI, 2.8 to 29.2; P = 0.021) were higher in the experimental group than in the control group. The experimental group had higher GSES scores and lower RPE and VAS scores on postoperative day 7 (all P < 0.05). Post-exercise femoral and popliteal venous flow velocities were also higher in the experimental group (both P < 0.05). DVT incidence did not differ significantly between groups (2% vs. 6%; absolute risk difference, −4.0 percentage points; 95% CI, −11.6 to 3.6; P = 0.617). Conclusions Quantifiable APE monitoring was associated with improved exercise adherence and favorable short-term rehabilitation-related and venous hemodynamic outcomes. However, the study was not powered to determine whether the intervention prevents DVT. Clinical Trial Registration https://www.chictr.org.cn/showproj.html?proj=200872 , identifier, ChiCTR2300073531. Registered on July 13, 2023.