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 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.