Total Joints: Do Smart Implants Improve Outcomes?

Data-driven devices aim to personalize recoveries in joint replacement.

Smart implants have long held the promise of transforming orthopedic care — from passive mechanical devices to active, data-generating tools that can enhance clinical insight and patient recovery. While research in this space dates back decades, only recently have smart implants been introduced into routine clinical use for total joint replacements.

Their impact is still being studied, but early insights from providers suggest smart implants may help improve patient engagement, support earlier identification of complications and contribute to more personalized postoperative care.

“Smart implants strive to enable personalized medicine,” says Eric H. Ledet, PhD, a professor at Rensselaer Polytechnic Institute in Troy, N.Y., who has researched smart orthopedic technologies for more than 25 years. “It’s about making very bespoke, customized decisions on care for individual patients.”

How smart implants are being used

Smart implants in total joints typically fall into two categories. The first — and currently more common — are diagnostic devices. These implants function like conventional implants while also collecting and transmitting data such as range of motion, step count or activity levels, says Dr. Ledet.

More advanced smart implants, which are still in development, could one day deliver therapeutic interventions, such as stimulating bone growth or responding to inflammation, based on real-time monitoring.

Jonathan M. Vigdorchik, MD, a hip and knee surgeon at Hospital for Special Surgery (HSS) in New York City, says smart implants can be used across the full spectrum of primary knee replacement cases. “Some surgeons are using them on all comers, while some surgeons are selecting specific patients in their practice,” he says. “The most important thing to consider is to make sure that the implant fits in that particular patient’s bone, which for the majority is just fine.”

While the earliest commercial smart implants track indirect indicators of recovery such as gait or step count, experts believe their primary value lies in engaging patients and identifying outliers in recovery progress.

“The smart implant itself is not what is responsible for improvements in patient outcomes for that individual patient,” says Dr. Vigdorchik. “The point of smart implants is twofold: One, to capture the recovery after knee replacement over an entire population of patients, and two, to capture the recovery of each individual patient and compare that recovery with all patients and similar patients so patients know if their recovery is on track, and so doctors can be alerted to patients who are recovering more slowly to intervene earlier.”

Involving patients in their recovery

One of the most immediate benefits of smart implants is patient engagement.

“It’s similar to what we’ve seen with smartwatches and fitness trackers,” says Dr. Ledet. “When patients have real-time feedback on their recovery and a target to hit, they’re more motivated to participate in their rehab.” In total knee replacements, where successful outcomes are tightly linked to postoperative rehabilitation, this engagement can make a meaningful difference. Dr. Vigdorchik notes that patients are excited to get real-time feedback on their recoveries and compare their results to those of others.

“Patients always want to know how they’re doing compared to everyone else,” says Dr. Vigdorchik. “Smart implants give them that feedback in real time.”

Smarter postoperative monitoring

Smart implants can also enable earlier detection of problems.

“We can track an individual patient’s recovery and compare it across an entire group of patients with similar age, demographics, deformity, diagnosis, to make sure the patient is on track or not, and then intervene with an office visit, targeting physical therapy, etc.,” says Dr. Vigdorchik.

“When patients have real-time feedback on their recovery and a target to hit, they’re more motivated to participate in their rehab.”
— Eric H. Ledet, PhD

While current commercial implants offer only indirect measures of recovery, Dr. Ledet believes future iterations will deliver much more actionable data.

“In the next generation, we’ll be able to measure indicators that directly reflect healing like pressure or force distribution, which can guide clinical decisions such as when it’s safe to stop physical therapy or return to work,” he notes.

Barriers to widespread use

Despite the promise, challenges remain, particularly when altering the design of the implant itself. “When you modify an implant that’s already been refined over decades, you have to be absolutely certain that you’re not compromising its structural integrity or long-term performance,” says Dr. Ledet.

There’s also the question of cost. Smart implants are more expensive than standard implants, and although they may help prevent complications down the line, the upfront expense can still be a barrier.

Dr. Vigdorchik notes that while the implants themselves are costlier, the hardware setup is minimal. He says the systems simply require software on the patient’s smartphone along with a base station in the patient’s home to sync the data.

Despite the added costs and additional steps to set up, there is potential for the implants to help reduce complication risks for surgical patients down the road.

“Cost is a barrier. The implant is more expensive,” says Dr. Vigdorchik. “But in the longer run, if complications can be prevented, this works out.”

Outside of cost, there may also be concerns from patients about their privacy. Dr. Vigdorchik says these concerns are overstated.

“Patients want to know if their location is being tracked — which it’s not,” he says. “Their data is private, well-secured and HIPAA-compliant.”

Smarter implants, smarter care

AGGREGATE ASSISTANCE When providers can track an individual patient’s recovery and compare it across an entire group of patients of similar age, demographics, deformity and diagnosis, they can ensure everything’s on track or intervene with an office visit or physical therapy.

The experts see rapid evolution ahead.

“I think this is the first domino,” says Dr. Ledet. “With a regulatory precedent now in place, more devices will follow, and they’ll be more sophisticated. First, we’ll see smarter diagnostics. Then, we’ll see implants that combine diagnostics with therapeutic responses.”

Dr. Vigdorchik anticipates that smart implants will one day go beyond measuring motion to detect early signs of implant loosening, instability or infection.

“I anticipate wider adoption,” he says. “Costs should come down, barriers to adoption will go away, and more widespread use will occur naturally — continuing to enhance the feedback loop and predictive analytics.” For now, smart implants give surgeons a new way to engage and support patients during recovery. While the technology is still evolving, the potential is clear: more personalized care, better data and earlier, smarter interventions.

“Smart implants are really about enabling personalized medicine,” says Dr. Ledet. “It’s not about replacing clinical judgment. It’s about giving clinicians better tools to make timely, tailored decisions.” OSM