Telerehabilitation after knee replacement, what clinicians need to know
Telehealth moved from the margins to the mainstream in a few short years. For rehabilitation after total knee replacement (TKR), the question clinicians now ask is not whether remote rehab is possible, but whether it is as good, and how to judge the tools that deliver it.
Does remote rehab work?
One of the most rigorous tests came from Quebec, Canada. A multicentre randomised trial of 205 patients compared telerehabilitation delivered into the home with standard face to face home visits after TKR. The trial was designed to test noninferiority, and a commentary in the Journal of Bone and Joint Surgery described it as a "very well done" study with excellent methodology (Spangehl, JBJS, 2015). A follow up paper from the same cohort found satisfaction was very high in both groups, above 85%, and concluded the results strongly support telerehabilitation to improve access and efficiency after TKR (Moffet et al., Telemedicine and e Health, 2017).
Newer data point the same way. A 2022 matched cohort study of 326 patients found telerehabilitation after TKR produced similar pain scores, similar gains in knee flexion and extension, and similar rates of unplanned care compared with conventional physiotherapy (LeBrun et al., Knee Surgery, Sports Traumatology, Arthroscopy, 2022).
Can a phone camera measure the knee?
Range of motion is one of the most important early markers after TKR, and traditionally it needs a goniometer and a clinic visit. Computer vision is changing that.
A 2025 study in Physiotherapy tested smartphone based markerless motion capture in 15 people with end stage knee osteoarthritis awaiting TKR. Against 3D motion capture, the gold standard, the smartphone system showed a mean difference of 0° for peak flexion, extension and range of motion, with 95% limits of agreement between ±6° and ±10°. The authors concluded it was a valid and reliable way to quantify knee range of motion, supporting its use for remote monitoring (Langley et al., Physiotherapy, 2025).
The sample was small and the study tested one platform, so results will not automatically apply to every app. But it shows the technology is now accurate enough to take seriously.
What to look for in a digital rehab tool
If you are considering a platform for your patients, these are the questions worth asking:
Is it regulated? Check whether it is included in the Australian Register of Therapeutic Goods and for what intended purpose.
Who sets the program? The clinician should prescribe and adjust the program, with the tool delivering it as intended.
What data comes back? Look for adherence, range of motion, pain and patient reported measures you can act on, not just logins.
Is the measurement validated? Ask for evidence behind any range of motion or movement quality figures.
Will your patients use it? Large text, audio cues and support for family or carers matter for an older TKR cohort.
Is the data secure? Look for recognised standards such as ISO 27001 and SOC 2.
The bottom line
Remote rehabilitation after TKR is supported by trial evidence, and camera based measurement is maturing quickly. The best results will come from tools that keep the clinician in charge of the program while giving them clear, reliable data between visits. That is the model BIBO is built on.
This article is general information for health professionals and is not clinical advice.
