Is the RomTech (Remote Technology) PortableConnect System effective for post-operative rehabilitation following total knee arthroplasty (TKA) in a patient with severe osteoarthritis (OA) and bone-on-bone articulations?

RomTech PortableConnect System for Post-TKA Rehabilitation

Direct Recommendation

The RomTech PortableConnect system should NOT be approved for this patient, as it is classified as experimental/investigational by major payers and lacks sufficient high-quality evidence, while established supervised exercise programs have strong evidence for improving outcomes after TKA. 1

Evidence-Based Rationale

What Guidelines Actually Support

Supervised exercise programs during the first 2 months after TKA have strong evidence for improving physical function and moderate evidence for decreasing pain. 1 The American Academy of Orthopaedic Surgeons provides a strong recommendation (moderate to strong evidence) that supervised rehabilitation—not device-based passive therapy—is the gold standard for post-TKA recovery. 1

Early mobilization starting on the day of surgery has strong evidence for reducing hospital length of stay and moderate evidence for reducing pain and improving function. 1, 2 This is fundamentally different from device-dependent rehabilitation systems.

The RomTech Evidence Problem

The Hayes Technology Assessment and Aetna policy both classify RomTech as experimental/investigational based on only 2 uncontrolled, nonblinded, poor-quality retrospective studies. This falls far short of the evidence threshold needed to recommend it over established therapies.

While one 2023 study 3 showed the home-based clinician-controlled therapy system (HCTS, which appears to be RomTech) had superior ROM, KOOS JR scores, and lower manipulation rates compared to standard physical therapy, this single study cannot override the strong guideline recommendations for supervised exercise programs. 1 Additionally, a 2025 patient satisfaction study 4 showed 93% satisfaction but did not demonstrate superiority over guideline-recommended care.

What Should Be Done Instead

This patient should receive supervised physical therapy beginning on the day of surgery, continuing for the first 2 months postoperatively. 1, 5, 2 This approach has:

• Strong evidence for improving physical function 1
• Limited to moderate evidence for decreasing pain 1
• Strong evidence for reducing hospital length of stay when started immediately 1, 2

The rehabilitation protocol should include:

• Immediate weight-bearing as tolerated on postoperative day 0 5, 2
• Isometric quadriceps exercises in the first week (provided they cause no pain) 5
• Cryotherapy in the first postoperative week for pain reduction 5, 6
• Immediate knee mobilization within the first week to increase ROM and prevent extension deficit 5
• Progression from isometric to closed kinetic chain exercises by week 2 5
• Neuromuscular electrical stimulation (NMES) can be added to isometric training for quadriceps re-education 5

What NOT to Use

Continuous passive motion (CPM) devices should be avoided, as strong evidence shows they do not improve outcomes after knee arthroplasty. 1, 2, 7 This is critical because device-based passive rehabilitation has been definitively shown to be ineffective.

Knee immobilizers should not be used, as they provide no benefit and may impede rehabilitation progress. 2

Cryotherapy devices (beyond simple ice application) have moderate evidence showing they do not improve outcomes. 1

Insurance Coverage Reality

The 2025 ETF Certificate explicitly excludes experimental and investigational treatments. Since Aetna Policy 0325 classifies RomTech as experimental/investigational, this request will likely be denied regardless of clinical merit. The provider should be prepared to justify why established, evidence-based supervised physical therapy is not being utilized instead.

Clinical Decision Algorithm

1. Is the patient able to attend supervised physical therapy sessions? If yes → proceed with supervised PT (strong evidence) 1
2. Is the patient highly motivated but unable to attend in-person PT? If yes → consider home-based physiotherapy with therapist supervision (may be as effective for motivated patients) 5
3. Does the patient have contraindications to standard rehabilitation? If no contraindications exist → there is no justification for experimental devices over proven therapies 1, 5

Common Pitfalls to Avoid

• Delaying mobilization leads to stiffness and extension deficits 5
• Failing to address quadriceps strength deficits significantly impacts long-term functional outcomes 5
• Choosing device-based passive therapy over active supervised exercise contradicts strong guideline recommendations 1, 2
• Assuming telerehabilitation devices are equivalent to supervised PT without high-quality comparative evidence 3, 8