Patient Portals Work Better for TKA Than THA?

How effective are patient portals—those secure online websites that give patients 24-hour access to their personal health information, education resources, doctor visits, discharge summaries, medications and so forth—in terms of attracting patients and, thereby, educating and preparing them for arthroplasty surgery? Can patient portals have an impact on improve patient reported outcomes measures (PROMS)?

With those questions in mind, a team of researchers from Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, organized a retrospective analysis of consecutive primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) to answer those questions.

Study co-author Andrew J. Holte, M.D. explained the background of this research to OTW. “In recent years there has been an expanding of body of literature regarding the use of patient portals in the setting of total joint arthroplasty. Previous studies laid groundwork identifying patient factors associated with higher portal enrollment as well as the impact of patient portal on clinical outcomes.”

The team enrolled 1,039 patients and then divided them into two groups—those who opted-in and those who opted-out of the portal. The team then followed the study participants for a minimum of 12 months.

Of the 1,039 patients, 60.6% (336) were treated with total hip arthroplasty (THA) and 62.7% (304) with total knee arthroplasty (TKA) and all enrolled in the portal. Those who chose to opt-in were younger, had higher body mass index, and a higher household income and this was true in both the THA and TKA groups.

In the TKA group the team found that portal participation was associated with significant improvement in physical function and joint-specific function. Among THA patients who opted-in, the team found that increased portal logins were associated with more rapid improvement and higher functional scores.

Why the Difference Between TKA and THA?

TKA patients enrolled in the portal logged into the portal an average of 11.8 times within the first 30 days of the procedure; for the THA group that number was nearly the same, 11.4

Dr. Holte explained the results of the study to OTW, “We found that after controlling for many patient factors that have been found to influence postoperative outcomes, that portal participation in the TKA but not the THA cohort was associated with significant improvement in physical function and joint specific function. Our findings suggest that there is an inherent difference between those patients that opt-in and those that opt-out of web-based portals. The extra resources and support provided by these portals may translate to improved PROMs in the TKA patients, but not in the THA patients.”

Why the difference? One possible explanation, say the study authors, is that primary THA has been shown to provide better outcomes than TKA. As a result, they postulate, “it is possible that providing TKA patients with more resources and guidance in the postoperative period translates into significantly improved outcomes.”