Rethinking That One-Year Follow-Up Rule

Only about 35% of patients who are scheduled for one-year follow-up actually make the appointment. Could one-year follow-up visits after primary hip and knee arthroplasty not be as valuable as some think?

Researchers from Washington University School of Medicine in St. Louis (WUSTL), Missouri, studied the registry data of 473 patients who underwent primary total hip (280), hip resurfacing (8), total knee (179), and unicompartmental knee arthroplasty (6) over nine months to get answers.

Their study, “The burden and utility of routine follow-up at one year after primary arthroplasty,” appears in the June 30, 2020 edition of The Bone & Joint Journal.

Co-author Charles M. Lawrie, M.D., a hip and knee surgeon at WUSTL and study co-author explained the reasons behind rethinking this nearly ubiquitous practice to OTW, “Most hip and knee arthroplasty surgeons recommend their patients return to the office for routine follow up at 1-2 years after primary hip or knee arthroplasty. As the number of hip and knee arthroplasties performed worldwide continues to grow, the burden of these routine office visits may become overwhelming to surgeons and their healthcare systems. We performed our study to investigate the burden and utility these visits provide to patients and providers.”

Getting to the heart of the matter, at the one-year follow-up visit, patients and attending surgeons were asked to complete surveys about the visit. Surgeons answered questions such as, “Were any interventions performed, ordered or scheduled?” “Were any problems or issues diagnosed or complications avoided by today’s visit?” and “Were the benefits of today’s visit worth the time and resources utilized for the visit?”

Patients answered questions such as, “How satisfied are you with the care you received from your surgeon at this follow-up appointment?” “Was today’s visit worth the time, effort, and cost?” “Would you have been satisfied with remote follow-up?”

Poor Compliance

“We found that despite reminders, patient compliance with the one-year routine follow up visit was low, with only 35% in attendance,” stated Dr. Lawrie. “Furthermore, routine visits did not detect any problems with the operated joint requiring intervention but did impose substantial time and monetary cost to patients. Despite this, the majority of patients who attended routine follow up visits believed the visits were worth the time, effort and cost; surgeons, however, were less enthusiastic about the utility of the routine one-year follow up visit, only rating about half of them as worthwhile.”

“Future work in this area should investigate the use of remote follow up strategies using artificial intelligence in conjunction with remotely performed plain radiographs, electronic surveys and wearable devices for routine surveillance of well-functioning hip and knee arthroplasties, as these technologies may be able to provide surgeons and patients information on the performance of the prosthesis without the burden of an office visit.”