Total Knee Replacement and the Effect of Technology on Cocreation for Improved Outcomes and Delivery: Qualitative Multi-Stakeholder Study

Yasmin van Kasteren, Jill Freyne, M. Sazzad Hussain

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Background: The growth in patient-centered care delivery combined with the rising costs of health care have perhaps not unsurprisingly been matched by a proliferation of patient-centered technology. This paper takes a multistakeholder approach to explore how digital technology can support the cocreation of value between patients and their care teams in the delivery of total knee replacement (TKR) surgery, an increasingly common procedure to return mobility and relieve pain for people suffering from osteoarthritis. Objective: The aim of this study was to investigate communications and interactions between patients and care teams in the delivery of TKR to identify opportunities for digital technology to add value to TKR health care service by enhancing the cocreation of value. Methods: A multistakeholder qualitative study of user needs was conducted with Australian stakeholders (N=34): surgeons (n=12), physiotherapists (n=3), patients (n=11), and general practitioners (n=8). Data from focus groups and interviews were recorded, transcribed, and analyzed using thematic analysis. Results: Encounters between patients and their care teams are information-rich but time-poor. Results showed seven different stages of the TKR journey that starts with referral to a surgeon and ends with a postoperative review at 12 months. Each stage of the journey has different information and communication challenges that can be enhanced by digital technology. Opportunities for digital technology include improved waiting list management, supporting and reinforcing patient retention and recall of information, motivating and supporting rehabilitation, improving patient preparation for hospital stay, and reducing risks and anxiety associated with postoperative wound care. Conclusions: Digital technology can add value to patients’ care team communications by enhancing information flow, assisting patient recall and retention of information, improving accessibility and portability of information, tailoring information to individual needs, and by providing patients with tools to engage in their own health care management. For care teams, digital technology can add value through early detection of postoperative complications, proactive surveillance of health data for postoperative patients and patients on waiting lists, higher compliance with rehabilitation programs, and reduced length of stay. Digital technology has the potential to improve patient satisfaction and outcomes, as well as potentially reduce hospital length of stay and the burden of disease associated with postoperative morbidity.

Original languageEnglish
Article numbere95
Number of pages13
JournalJournal of Medical Internet Research
Issue number3
Publication statusPublished - 20 Mar 2018
Externally publishedYes

Bibliographical note

©Yasmin van Kasteren, Jill Freyne, M Sazzad Hussain. Originally published in the Journal of Medical Internet Research
(, 20.03.2018. This is an open-access article distributed under the terms of the Creative Commons Attribution
License (, which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete
bibliographic information, a link to the original publication on, as well as this copyright and license information
must be included.


  • arthroplasty
  • replacement
  • osteoarthritis
  • patient participation
  • consumer health informatics
  • technology
  • telemedicine
  • rehabilitation
  • self-care
  • exercise therapy
  • human computer interaction
  • wearables
  • Patient participation
  • Arthroplasty
  • Replacement
  • Self-care
  • Human computer interaction
  • Telemedicine
  • Technology
  • Exercise therapy
  • Wearables
  • Rehabilitation
  • Osteoarthritis
  • Consumer health informatics


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