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The Fate of Patients Not Returning for Follow-up Five Years After Total Knee Arthroplasty
Paul J. King, MD1; Andrew S. Malin, BS2; Richard D. Scott, MD2; Thomas S. Thornhill, MD2
1 Anne Arundel Orthopaedic Surgeons, 2003 Medical Parkway, Suite 400, Annapolis, MD 21401. E-mail address: pjking10@msn.com
2 Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. One or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (DePuy, a Johnson and Johnson Company). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at Brigham and Women's Hospital and New England Baptist Hospital, Boston, Massachusetts

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 May 01;86(5):897-901
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Background: Patients who do not return for follow-up after total knee arthroplasty are often assumed to have had a worse outcome. We postulated that the Internet may be useful for locating patients who do not return for follow-up. The purpose of this study was to compare outcomes between patients who attended prescribed postoperative appointments and those who did not.

Methods: We retrospectively reviewed the outcomes for 161 patients (200 knees) at a minimum of five years after a total knee replacement. All patients who had had no contact of any type with their surgeon in any manner beyond six months following the date of the surgery were classified as not having returned for follow-up. When patients could not be located with use of all available information in their chart, a standardized Internet search algorithm was employed with use of readily available and free search engines.

Results: Thirty patients with thirty-five treated knees met the definition of not returning for follow-up. Thirteen patients could not be located with use of the contact information given at their last visit. All were located with use of the Internet. None of the patients had had knee surgery elsewhere. The reasons for not adhering to the prescribed postoperative regimen were identified. The group had improved Knee Society pain and function scores compared with the preoperative values, and the patients were not significantly different from those who did return for follow-up.

Conclusions: The patients who did not attend follow-up appointments in this series had not had any additional surgery and did not have any significant differences in measured outcome variables when compared with patients who had complied with a follow-up protocol. The Internet proved to be a valuable tool for locating patients who had not returned for follow-up postoperatively.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Gurdev S. Gill
    Posted on July 04, 2004
    Fate of Patients Not Returning for Follow Up after TKA

    To the Editor:

    I would like to congratulate King, et. al., for highlighting an important issue, the outcomes of patients who do not participate in prescribed follow-up evaluations.This issue has already been addressed in a paper I co-authored (1).

    It had been falsely assumed that patients who failed to keep follow-up appointments were likely to have had poor outcomes or that they had revision surgery elsewehere. These two publications has been proven this assumption to be wrong. I believe this fact should be empahisized more widely.


    1. Joshi, AB; Gill,GS; Smith,PL, "Outcome in Patients Lost to Follow-Up," J.Arthroplasty, 2003:18(2), 149-153.

    Gurdev S. Gill, MD

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