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

Authors

  • Thomas J. Hendricks, M.D. University of Kansas School of Medicine-Wichita, Department of Orthopaedics, Wichita, KS
  • Alexander C.M. Chong, MSAE, MSME University of Kansas School of Medicine-Wichita, Department of Orthopaedics, Wichita, KS, Sanford Health, Sanford Orthopedics & Sports Medicine, Fargo, ND, Sanford Health, Sanford Sports Science Institute, Sioux Falls, SD
  • Robert P. Cusick, M.D. University of Kansas School of Medicine-Wichita, Department of Orthopaedics, Wichita, KS; Kansas Orthopaedic Center, PA., Wichita, KS

DOI:

https://doi.org/10.17161/kjm.v11i3.8692

Keywords:

arthroplasty, follow-up care, survey, cost of illness

Abstract

Introduction. Many physicians recommend annual or biennial visits
after total hip and knee arthroplasty (THA and TKA). This study
sought to establish the cost of a post-operative visit to both the health
care system and patient and identify if these visits altered patient
management.


Methods. A prospective cohort study was conducted using patients
presenting for follow-up after THA or TKA from April through
December 2016. All surgeries were performed by a single orthopaedic
surgeon in Wichita, Kansas. All eligible subjects that met the inclusion
criteria received and completed a questionnaire about the personal
cost of the visit and their assessment of their function and outcome
after total joint arthroplasty. The physician also completed a questionnaire
that examined the cost of the visit to the health care system
and 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 time
for the patient was 3.9 ± 2.9 hours. Eighty percent of patients reported
no pain during the clinic encounter, and 11% reported loss of function.
Eighty-four percent thought the visit was necessary. Physician time
for each visit lasted 12.9 ± 3.7 minutes (range, 10 - 20 minutes). Only
9% of patient encounters resulted in an alteration in patient management.
This occurred at an average follow-up time of 3.6 ± 1.8 years
after the index procedure. The average cost of each visit to the health
care system at large was $117.31 ± 60.53 (range, $93.90 - $428.28).


Conclusions. The findings of this study advise total joint patients and
orthopaedic surgeons regarding the cost of routine post-operative
appointments and whether these visits alter patient management.
The majority of the routine follow-up visits after THA and TKA did
not result in an alteration in patient management, but added substantial
cost to the health care system. Kans J Med 2018;11(3):59-66.

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Published

2019-01-15

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Section

Original Research