Objective functional assessment in orthopedics: The emerging role of wearable technologies

Table 1 Wearables in total joint arthroplasty

Ref.	Type of surgery	Device used	Key findings
Kuiken et al[59], 2004	TKA	Custom Goniometer	Patients had higher mean total activity rates on days they were not receiving device feedback compared to days they did receive feedback during TKA recovery, measured by ROM and mean activity rate
Kwasnicki et al[63], 2015	TKA	e-AR accelerometer (Imperial College London)	A rate of 89% accuracy was achieved in classifying patients into preoperative, normal, and 24-week postoperative groups based on outcomes, measured by TUG time and ROM
Toogood et al[53], 2016	THA	Fitbit accelerometer (Fitbit LLC)	Mean compliance over 30 days was 26.7 days, or 89%
Chiang et al[66], 2017	TKA	APDM OPAL	A rate of 17% of patients felt uncomfortable with the sensor belt, measuring patient satisfaction
Van der Walt et al[65], 2018	TKA/THA	Garmin Vivofit 2 accelerometer (Garmin Ltd)	Patients receiving device feedback had significantly higher mean daily step counts than those who did not receive device feedback
Saporito et al[64], 2019	THA	Custom accelerometer and barometer	Remote TUG can be estimated in older adults using 3-day of ADLs from a wearable pendant

TKA: Total knee arthroplasty; THA: Total hip arthroplasty; ROM: Range of motion; TUG: Timed Up and Go; ADLs: Activities of daily living.

Table 2 Wearables in orthopedic trauma

Ref.	Patient population	Wearable device(s)	Key findings
Taraldsen et al[91], 2014	Elderly patients post-hip fracture in RCT	Accelerometer-based activity monitor	Patients receiving comprehensive geriatric care spent more time upright and recovered function more quickly than controls
Kammerlander et al[89], 2018	Older hip fracture patients post-surgery	Pressure-sensing insoles	Patients frequently exceeded prescribed partial weight-bearing. Wearables objectively revealed poor adherence to weight-bearing restrictions
Marmor et al[88], 2022	Patients with orthopedic trauma (systematic review)	Multiple (accelerometers, pressure insoles, etc.)	Wearable monitors are increasingly used to assess recovery post-fracture. Most commonly studied in hip and fragility fractures
Lockhart et al[94], 2021	Community-dwelling older adults	Sternum-mounted IMU	Gait variability and complexity predicted future falls over 6 months with approximately 82% accuracy. Validated use of wearables in fall risk assessment

RCT: Randomized controlled trial.

Table 3 Wearables in spine surgery

Ref.	Type of surgery	Device used	Key finding
Natarajan et al[109], 2022	Degenerative lumbar spine disease (observational study)	Chest-based inertial wearable sensor (MetaMotionC)	Distinct gait patterns were observed for lumbar disc herniation, spinal stenosis, and chronic mechanical low back pain. LSS showed gait asymmetry and variability; LDH showed reduced gait velocity and cadence
Sheeran et al[110], 2024	Persistent non-specific low back pain	IMUs	Significant variations in range of motion during flexion, extension, and lateral flexion
Boutaayamou et al[114], 2025	Gait analysis	IMU-based system	Intraclass correlation coefficients exceeded 0.90 for spatiotemporal gait parameters including stride length, cadence, and speed, indicating an accurate method for analysis using IMUs
Bienstock et al[115], 2022	Lumbar laminectomy	Accelerometry	Continuous data from accelerometers effectively delineates 3 distinct stages of postop recovery and supplemented patient-reported outcomes
Inoue et al[116], 2020	Lumbar spinal surgery	Wearable activity tracker	Activity decreased 1 month postop followed by gradual recovery within 3 months although patient-based outcomes already indicated improvement at 1 month
Smuck et al[117], 2018	Lumbar spinal stenosis decompression	Wearable activity monitors (e.g., accelerometers)	6 months after surgery participants demonstrated significant improvements in self-reported function and objectively measured physical capacity, but real-life physical activity remained stagnant
Schulte et al[120], 2010	Lumbar decompression surgery	Step activity monitor (accelerometer-based)	Objective step activity increased post-surgery, indicating improved functional mobility
Sakaguchi et al[38], 2024	Corrective spinal fusion surgery	Triaxial accelerometer	Gait sway and motor function improved significantly post-surgery, measurable via accelerometry

IMU: Inertial measurement unit; LSS: Lumbar spinal stenosis; LDH: Lumbar disc herniation.

Table 4 Wearables in sports medicine

Ref.	Type of surgery	Device used	Key finding
Bell et al[143], 2017	ACL reconstruction	Accelerometer (Actigraph)	Only 24% of post-operation patients met the recommended steps guideline. Moderate-to-vigorous physical activity was also significantly lower in postop patient
Dwyer et al[144], 2025	ACL reconstruction	Accelerometer	Physical activity outcomes during the first year of recovery showed gradual improvement, but physical activity targets were still not met at 3 months, 6 months, or 12 months postop
Werner et al[145], 2025	ACL reconstruction	Waist-worn accelerometer (Actigraph)	Average daily steps did not change from 6 months to 18 months post-ACL reconstruction
Laurent et al[148], 2020	Achilles tendon rupture recovery	Wearable insole sensors	Plantar pressure distribution and activity demonstrated little improvement at 12 weeks
Tavakkoli Oskouei et al[149], 2022	Achilles tendinopathy	Wearable technology	Daily physical activity and biomechanical measures were evaluated and changes in pain were not found to correlate with activity levels
Boyer et al[150], 2025	Shoulder physiotherapy	Smartwatch	Higher physiotherapy participation rates led to significant improvements for partial-thickness tears
Burns et al[151], 2021	Rotator cuff physiotherapy	Smartwatch	Clinically significant dose response of physiotherapy on treatment outcomes in rotator cuff pathology
Burns et al[152], 2018	Shoulder physiotherapy	Smartwatch (Inertial signals)	Machine learning successfully recognized shoulder physiotherapy exercises from smartwatch inertial signals

ACL: Anterior cruciate ligament.