The Journal of Bone and Joint Surgery (American). 2008;90:1848-1854.
doi:10.2106/JBJS.G.00856
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Patient Compliance with Clinical Follow-up After Total Joint Arthroplasty

John C. Clohisy, MD1, Ganesh V. Kamath, MD1, Gregory D. Byrd, MD2, Karen Steger-May, MA3 and Rick W. Wright, MD1

1 Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Hospital Plaza, Suite 11300 West Pavilion, St. Louis, MO 63110. E-mail address for J.C. Clohisy: jclohisy{at}msnotes.wustl.edu
2 Oregon Health and Science University, 5310 SW Brugger Street, Portland, OR 97219
3 Division of Biostatistics, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8067, St. Louis, MO 63110

Investigation performed at the Department of Orthopaedic Surgery, Barnes-Jewish Hospital at Washington University School of Medicine, St. Louis, Missouri

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from a Wright Medical Clinical Research Grant. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Periodic clinical and radiographic evaluation is commonly recommended by orthopaedic surgeons to monitor patients following total joint arthroplasty, yet the compliance with and efficacy of patient follow-up protocols have not been well defined. The purpose of this study was to evaluate patient compliance with early clinical follow-up after total hip arthroplasty or total knee arthroplasty.

Methods: We performed a retrospective review of clinical follow-up compliance for 776 patients who had undergone a total joint arthroplasty in the lower extremity. This cohort included 505 total hip arthroplasties (372 primary and 133 revision procedures) and 271 total knee arthroplasties (195 primary and seventy-six revision procedures). The patients were given one-time verbal instructions by the treating surgeon at the three-month postoperative visit to return for the one-year follow-up evaluation. At the one-year follow-up evaluation, those who returned were once again verbally instructed to return a year later. Demographic factors, functional hip and knee scores, and follow-up compliance at one and two years after surgery were assessed.

Results: Patient compliance with clinical follow-up after all arthroplasties was 61% at one year and 36% at two years. With use of a multivariate model for patients who had total hip arthroplasty, the analyses showed that a revision hip procedure (p = 0.006), younger patient age (p = 0.04), and a higher preoperative Harris hip score for gait (p = 0.04) were associated with follow-up compliance at two years. Of the factors analyzed for patients who had total knee arthroplasty, only nonwhite race (p = 0.03) was found to be a positive predictor of follow-up compliance at the two-year follow-up interval.

Conclusions: Patient compliance with clinical follow-up after total joint arthroplasty in response to a verbal request made by the surgeon once at three months and once at one year postoperatively was poor in this series. These data indicate that this method (one-time verbal instruction) is insufficient to ensure compliance for follow-up after total joint arthroplasty.


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