The Cost of Routine Follow-Up in Total Joint Arthroplasty and the Influence of These Visits on Treatment Plans

Abstract

Introduction. Many physicians recommend annual or biennial visitsafter total hip and knee arthroplasty (THA and TKA). This studysought to establish the cost of a post-operative visit to both the healthcare system and patient and identify if these visits altered patientmanagement. Methods. A prospective cohort study was conducted using patientspresenting for follow-up after THA or TKA from April throughDecember 2016. All surgeries were performed by a single orthopaedicsurgeon in Wichita, Kansas. All eligible subjects that met the inclusioncriteria received and completed a questionnaire about the personalcost of the visit and their assessment of their function and outcomeafter total joint arthroplasty. The physician also completed a questionnairethat examined the cost of the visit to the health care systemand whether the clinical or radiographic findings altered patient management. Results. Fifty-six patients participated with an average length of follow-up of 4.5 ± 4.1 years since surgery. The average patient cost was$135.20 ± $190.53 (range, $1.65 - $995.88), and the average visit timefor the patient was 3.9 ± 2.9 hours. Eighty percent of patients reportedno pain during the clinic encounter, and 11% reported loss of function.Eighty-four percent thought the visit was necessary. Physician timefor each visit lasted 12.9 ± 3.7 minutes (range, 10 - 20 minutes). Only9% of patient encounters resulted in an alteration in patient management.This occurred at an average follow-up time of 3.6 ± 1.8 yearsafter the index procedure. The average cost of each visit to the healthcare system at large was $117.31 ± 60.53 (range, $93.90 - $428.28). Conclusions. The findings of this study advise total joint patients andorthopaedic surgeons regarding the cost of routine post-operativeappointments and whether these visits alter patient management.The majority of the routine follow-up visits after THA and TKA didnot result in an alteration in patient management, but added substantialcost to the health care system. Kans J Med 2018;11(3):59-66.