## 4 Discussion
These results highlighted the potential benefits of implementing direct contact to simplify communication between patients and surgeons, especially in the HBR context. In the future, the increased use of mobile devices and AI in daily life may help to improve adherence to HBR after surgery. Physicians can leverage these devices to supervise patients' exercise effectively, while patients can provide timely feedback to their physicians on the effectiveness of their treatment when they are far away or find it inconvenient to come to the hospital [10]. Moreover, AI tools can also be used to detect surgical wound problems through telemedicine [44]. Indeed, a review [45] demonstrated that telemedicine is an alternative for post-operative follow-up care that can identify surgical site infections with an accuracy of 70-100%. The socio-economic burden aspect of rehabilitation is no less important. In current study, the average cost of HBR was EUR 800, compared with the approximately EUR 250 daily average of the CBR. A meta-analysis by [PERSON] et al. [11] reported that the social cost of HBR was lower than that of CBR, with a cost-effectiveness advantage of about 43%. These data can also be reported in different health systems, suggesting a cost saving when using HBR rather than CBR. In our study, a comparison between HBR and CBR in terms of direct costs was not possible. It should also be considered that the costs associated with the health care provided by the physiotherapist and surgeon, the technology used, and daily living were not the aim of the study and were not investigated in depth; however, it would be useful to evaluate such costs in future studies, as this would further support the greater effectiveness of HBR over CBR. Our study allowed us to evaluate functional outcomes and pain in the short term, and thus enabled an immediate response on the effectiveness of the therapy by the patient. Our study also allowed assessment of the effectiveness of a timely response in case of complications. However, this study has several limitations. First, the sample size was limited, and the results reported were obtained at a short-term follow-up (1 month). Second, the patient allocation was decided by the patient himself, based on economic possibilities and the possibility of the presence of a caregiver. Third, any statistical differences relating to times of execution or exercise sessions between the two groups were not assessed. Fourth, we excluded cases with neurological disorders and orthopedic diseases of the lower limbs, and clinical scores were not considered to evaluate bone quality or mental status [46; 47]. These conditions may be present in other patients and may affect their postoperative outcomes; moreover, these factors could influence the decision for treatment and rehabilitation in addition to having already been associated with impaired functional recovery after various orthopedic procedures [48; 49]. Fifth, we did not analyze any functional assessment or range of motion that could be more useful in a long-term study. In conclusion, we found that there were no differences between HBR and CBR for patients who underwent TKA and THA in terms of functional outcomes and pain at 1 month after surgery. Greater preoperative joint functionality, a lower level of pain, and a female gender all predicted greater functional outcomes at 1 month after surgery in both groups. HBR is therefore confirmed as a valid option. In addition, it also seems more affordable than traditional CBR. Further studies with larger numbers of patients, longer follow-up times, and direct cost evaluations are required to confirm these findings and help to confirm the validity of HBR as a replacement of CBR in terms of compliance, functional outcomes, complications, and economic burden.