Abstract
Rising health costs have seen increased emphasis on cost containment. Outpatient follow-up after total joint arthroplasty is one such accumulating cost. Enthusiastic recent media interest in failing implants and unacceptable waiting lists adds further interest to the area.
We wished to determine the current post-operative follow-up practices and views of New Zealand Orthopaedic Surgeons. A postal survey was sent to all New Zealand Orthopaedic Surgeons.
The response rate was 83% (131/158). There was wide variation in routine practice and beliefs. For cemented THJRs, 13% of surgeons routinely saw their patients for less than one year, 38% followed their patients for less than five years and 53% continued to see patients indefinitely. Follow-up for uncemented/hybrid prostheses was higher: 8% for < one year, 29% for < 5 years and 59% indefinitely. A system of periodically re-calling patients for x-rays without necessarily seeing them is used by 20% of surgeons.
The most frequent reasons given for follow-up were the detection of osteolysis, wear, loosening and patient symptoms.
Similar figures for total and uni-compartmental knee replacements were reported.
Almost a third of surgeons reported that they were unable to follow-up their patients as they would like to because of resource limitations within the public health sector. 44% believed that future changes in medico-legal expectations will necessitate longer follow-up of patients.
This survey demonstrates wide variation in practice. Higher follow-up rates for un-cemented/hybrid prostheses may reflect uncertainty about the long-term results. There is concern amongst surgeons that their ability to follow-up patients within the public health-care sector is constrained by cost. Periodic questionnaire and x-ray assessment was suggested by many as a possible alternative for long-term follow-up of selected patients. Few surgeons are however presently using such a system. We propose a standard of care.
The abstracts were prepared by Jean-Claude Theis. Correspondence should be addressed to him at Department of Orthopaedic Surgery, Dunedin Hospital, Private Bag 1921, Dunedin, New Zealand.
