Scientific Articles   |    
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; 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@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
View Disclosures and Other Information
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.
Investigation performed at the Department of Orthopaedic Surgery, Barnes-Jewish Hospital at Washington University School of Medicine, St. Louis, Missouri

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Sep 01;90(9):1848-1854. doi: 10.2106/JBJS.G.00856
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


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.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    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.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    Oregon - The Center - Orthopedic and Neurosurgical Care and Research
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    Massachusetts - UMass Memorial Medical Center