title: Loss to follow-up in orthopaedic clinical trials: a systematic review.
abstract: The rate of patients lost to follow-up may contribute to bias in randomized controlled trials (RCTs).
  
  
  
  We systematically reviewed orthopaedic RCTs from 2008 to 2011, including 559 RCTs with 131,836 enrolled subjects. The loss to follow-up rates and minimum follow-up times were recorded for each trial. Orthopaedic subspecialty, country of origin, number of enrolled patients, patient age, follow-up strategy, and funding type were also recorded.
  
  
  
  Loss to follow-up was not reported in 111 of these studies (20 %). Mean loss to follow-up was 10.4 %. No orthopaedic subspecialty demonstrated significantly different follow-up rates. Remote follow-up strategies did not reduce the loss to follow-up rate. Studies with a minimum follow-up length of three years showed significantly higher loss to follow-up rates compared with studies with shorter minimum follow-up time (14.8 % versus 9.8 %, p = 0.01). Studies performed in the United States had a significantly higher rate of loss to follow-up compared with non-United States studies (13.8 % versus 9.4 %; p = 0.01).
  
  
  
  Loss to follow-up rates in published orthopaedic randomized controlled trials is overall relatively low. A substantial portion of publications does not adequately report follow-up data. Studies performed in the United States and studies with longer follow-up periods seem to be at higher risk for loss to follow-up.
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX, 78229, USA.
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Somerson
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX, 78229, USA.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Bartush
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX, 78229, USA.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Shroff
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX, 78229, USA. zelle@uthscsa.edu.
authors.forename: Boris A
authors.initials: BA
authors.lastname: Zelle
mesh_terms: D002986:Clinical Trials as Topic / Q000706:statistics & numerical data*; D003187:Compliance; D006801:Humans; D059012:Lost to Follow-Up; D009985:Orthopedics / Q000706:statistics & numerical data*
keywords: Clinical Trial; Compliance; Orthopaedic Surgery; Outcome