title: Patient compliance with clinical follow-up after total joint arthroplasty.
abstract: 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.
authors.affiliation: Department of Orthopaedic Surgery, Barnes-Jewish Hospital at Washington University School of Medicine, One Barnes-Hospital Plaza, Suite 11300 West Pavilion, St. Louis, MO 63110, USA. jclohisy@msnotes.wustl.edu
authors.forename: John C
authors.initials: JC
authors.lastname: Clohisy
authors.forename: Ganesh V
authors.initials: GV
authors.lastname: Kamath
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Byrd
authors.forename: Karen
authors.initials: K
authors.lastname: Steger-May
authors.forename: Rick W
authors.initials: RW
authors.lastname: Wright