Futuristic hospital room with holographic patient data displays.

Joint Replacement Revolution: Can Telemonitoring Cut Costs and Infections?

Lena Kashyap in Health & Wellness November 2026 • 4 min read.

"Discover how automated systems are transforming post-operative care, offering a lifeline for patients and significant savings for hospitals."

Surgical site infections (SSIs) represent a significant challenge in healthcare, leading to increased costs and complications, especially after joint replacement surgeries. Traditionally, hospitals have relied on manual follow-up processes, which are labor-intensive and prone to inconsistencies. Innovative solutions are needed to enhance patient care while optimizing resource allocation.

Telemonitoring systems are emerging as a promising solution to address these challenges. By automating communication and data collection, these systems can improve patient adherence to pre- and post-operative protocols, facilitate early detection of potential complications, and reduce the burden on healthcare staff. Two such systems, EpxDecolonization (EpxDecol) and EpxWound, have been developed and implemented at Washington University to enhance the management of orthopedic joint replacement patients.

This article examines the impact of EpxDecol and EpxWound on patient engagement, infection prevention, and cost savings over an 88-week period. We delve into how these systems work, the outcomes observed, and the potential for broader application in surgical care.

AI Search Multiple angles on this topic

History

From Early Signals to Remote Monitoring

Telemedicine's documented timeline spans notable events from 1905 to 2020. In 1905, Dutch physiologist Willem Einthoven transmitted the first electrocardiogram data from a laboratory to a home, an event identified as the earliest known telemedicine milestone. Remote patient monitoring later developed through advances including the telephone and NASA's early use of remote monitoring, leading toward today's remote-care systems.

How Automated Telemonitoring Works: A Step-by-Step Guide

Futuristic hospital room with holographic patient data displays.

EpxDecol focuses on the critical pre-operative phase, ensuring patients adhere to decolonization protocols designed to reduce the risk of Staphylococcus aureus infections. Six days before surgery, patients receive automated messages asking if they have collected their prescribed decolonization supplies, which include mupirocin nasal ointment and chlorhexidine gluconate cleanser.

EpxWound steps in post-operatively, from day 5 to day 19, to monitor pain levels and signs of infection. Patients receive daily messages inquiring about their pain, wound status (redness, drainage, odor), and body temperature. The system is designed to detect early warning signs of SSIs, allowing for timely intervention.

EpxDecol: Starts 6 days before surgery, ensuring patients pick up and use their decolonization supplies.
EpxWound: Begins 5 days post-op, monitoring pain, wound condition, and temperature.
Alert System: Sends alerts to nurses for patients reporting issues, enabling quick follow-up.
Patient Surveys: Gathers feedback on care quality and communication effectiveness.

AI Search Multiple angles on this topic

Latest Research

Evidence for Lower Utilization

Recent research has examined patient-reported outcome monitoring and alerts after joint replacement. A secondary analysis of the PROMoting Quality RCT reported post-surgery health-expenditure reductions of 7.9% for hip replacements and 7.3% for knee replacements. A separate multicentre randomized controlled trial underlying a cost-effectiveness analysis included 3,697 hip-replacement patients and 3,110 knee-replacement patients enrolled from 2019 to 2020 across nine German hospitals.

Counterpoints

Bias and Evidence Limitations

Remote follow-up after joint replacement has been studied through smartphone apps, telemedicine, and wearable activity sensors. A narrative review assessed each study's design, sample size, follow-up period, comparator, measurement methods, and reporting of funding and conflicts of interest. These evaluation criteria were used to contextualize the risk of bias across the evidence base.

Comparison

Teleconsultation Versus In-Person Care

A review of telemedicine in total joint arthroplasty describes teleconsultation as one approach to continuous, patient-centered postoperative care. In the review's summary of Windsor et al., teleconsultation for total joint arthroplasty patients was associated with diagnostic accuracy and outcomes comparable to in-person care. This comparison supports teleconsultation as a potential complement to traditional postoperative visits.

If a patient reports any concerning symptoms—such as increased redness, drainage, odor, a fever of 101°F or higher, or significant pain—an alert is immediately sent to the nurse in charge, prompting a follow-up phone call within two hours during business hours or the following morning if after hours.

The Future of Surgical Care: Telemonitoring and Beyond

EpxDecol and EpxWound represent a significant step forward in optimizing surgical care. By leveraging technology to enhance patient engagement and streamline follow-up processes, these systems offer a model for improving outcomes and reducing costs. As healthcare continues to evolve, telemonitoring solutions will likely play an increasingly important role in delivering efficient, patient-centered care across various surgical specialties.

Putting remote-care results in context

89.29% of patientsIn a virtual joint replacement clinic follow-up survey, 89.29% of patients said they were satisfied or very satisfied. This is a satisfaction share, not a measure of infection prevention or cost savings.^[1]
103.23; 80.71 odds ratioWound drainage was strongly associated with prosthetic joint infection (PJI): moderate-to-severe drainage in the third week had an odds ratio of 103.23, while newly developed drainage in the second week after a week without drainage had an odds ratio of 80.71. These are associations, not absolute infection probabilities.^[2]

What remote monitoring can-and cannot-show

Early recognition matters because delays in treating surgical-site infection are associated with greater morbidity and mortality. That makes timely detection a meaningful goal, but it does not show that every alert system achieves it or improves patient outcomes.^[3]

Remote assessment has practical limits: a video or image cannot fully reproduce an in-person orthopedic examination, and image quality and connectivity can affect reliability. A monitoring result therefore may not capture every clinically important feature of a patient’s condition.^[4]

What remains uncertain about remote joint care

Do remote wound checks perform consistently across telephone and video assessments when training and delivery are standardized? Existing observations did not separate those methods or standardize how telemedicine was delivered.^[5]
Would cost and outcome differences persist beyond the period directly observed? The economic analysis did not project results beyond its trial window, so it does not answer that longer-term question.^[6]

Terms used in remote-care evidence

Within-trial cost-effectiveness: An economic approach that analyzes costs and outcomes observed during a trial without projecting beyond its duration.^[6]
Postoperative home monitoring: A remote system that transmits blood pressure, heart rate, oxygen saturation, and pain scores using a tablet and monitoring devices.^[7]

Sources

Effectiveness, Patient Satisfaction, and Cost Reduction of Virtual Joint Replacement Clinic Follow-Up of Hip and Knee Arthroplasty (pmc.ncbi.nlm.nih.gov)
Wound drainage after arthroplasty and prediction of acute prosthetic joint infection: prospective data from a multicentre cohort study using a telemonitoring app (pmc.ncbi.nlm.nih.gov)
Remote diagnosis of surgical-site infection using a mobile digital intervention: a randomised controlled trial in emergency surgery patients (pmc.ncbi.nlm.nih.gov)
Telemedicine in total joint arthroplasty: toward continuous and patient-centered postoperative care (pmc.ncbi.nlm.nih.gov)
Use of Telemedicine for Postdischarge Assessment of the Surgical Wound (pmc.ncbi.nlm.nih.gov)
Cost-effectiveness of a patient-reported outcome-based remote monitoring and alert intervention for early detection of critical recovery after joint replacement: A randomised controlled trial (pmc.ncbi.nlm.nih.gov)
Postoperative Home Monitoring After Joint Replacement: Feasibility Study (pmc.ncbi.nlm.nih.gov)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

Everything You Need To Know

What is EpxDecol, and why is it used before joint replacement surgery?

EpxDecol is a telemonitoring system designed to ensure patients adhere to decolonization protocols before surgery. It focuses on reducing the risk of Staphylococcus aureus infections by sending automated messages to patients six days before their joint replacement surgery, reminding them to collect and use their prescribed decolonization supplies, such as mupirocin nasal ointment and chlorhexidine gluconate cleanser. This is significant because pre-operative decolonization is crucial in preventing surgical site infections. Without such a system, patients may not consistently follow the protocols, leading to a higher risk of infection and potential complications. EpxDecol helps standardize and reinforce this critical step in pre-operative care.

What is EpxWound, and how does it help patients after joint replacement surgery?

EpxWound is a telemonitoring system used post-operatively to monitor patients for signs of infection and pain levels after joint replacement surgery. Starting five days post-op and continuing through day 19, patients receive daily automated messages inquiring about their pain, wound status (redness, drainage, odor), and body temperature. The significance of EpxWound lies in its ability to detect early warning signs of surgical site infections (SSIs). If patients report concerning symptoms, the system alerts the nurse in charge, prompting a timely follow-up. Without such monitoring, infections may go undetected for longer, leading to more severe complications and increased healthcare costs. This system helps in early intervention and better patient outcomes.

What are surgical site infections (SSIs), and why is it important to prevent them?

Surgical site infections (SSIs) are infections that occur after surgery at the site of the incision. These infections can lead to increased healthcare costs, longer hospital stays, and potential complications for patients undergoing procedures like joint replacement. Preventing SSIs is vital because they can significantly impact patient recovery and overall outcomes. Traditional methods of monitoring for SSIs often rely on manual follow-up processes, which can be labor-intensive and inconsistent. Telemonitoring systems like EpxDecol and EpxWound offer a more efficient and reliable way to detect and prevent SSIs, ultimately improving patient care and reducing healthcare costs.

How can telemonitoring systems help reduce costs in joint replacement aftercare?

Telemonitoring systems, like EpxDecol and EpxWound, can lead to significant cost savings in healthcare settings. By automating communication and data collection, these systems improve patient adherence to protocols, facilitate early detection of complications, and reduce the burden on healthcare staff. Early detection and intervention can prevent more severe infections and complications, which often require costly treatments and extended hospital stays. Moreover, these systems optimize resource allocation by reducing the need for manual follow-up processes, freeing up healthcare staff to focus on other critical tasks. The result is more efficient, cost-effective patient care.

Why is an alert system important within a telemonitoring solution?

An alert system within telemonitoring solutions is crucial for ensuring timely intervention when patients report concerning symptoms. The alert system is designed to notify healthcare providers, such as nurses, immediately when a patient reports issues like increased redness, drainage, odor, a fever of 101°F or higher, or significant pain. Once an alert is received, the nurse is prompted to follow up with the patient within two hours during business hours, or the following morning if the alert is received after hours. This quick response is vital for addressing potential complications early, preventing them from escalating into more serious conditions. Without an efficient alert system, critical warning signs might be missed, leading to delayed treatment and poorer patient outcomes.