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Extent of Followup Care After Elective Total Hip Replacement
PAOLA de PABLO, ELENA LOSINA, NIZAR MAHOMED, JOHN WRIGHT, ANNE H. FOSSEL, JANE A. BARRETT, and JEFFREY N. KATZ ABSTRACT. Objective. To estimate the extent of radiographic and orthopedic followup among recipients of total hip replacement (THR), and to identify patients who are less likely to have consistent followup over 6 years postoperatively. Methods. We studied a population-based sample of 622 patients who received THR in 1995. We developed a multivariate ordinal regression model with the extent of radiographic followup as the dependent variable (none, early, and consistent), adjusting for demographic and preoperative clinical characteristics, and hospital and surgeon volume. Results. Ninety-four (15%) patients indicated that they had no followup radiographs, 269 (43%) had early followup only, and 259 (42%) had consistent followup radiographs over 6 years. Ninety percent of those with consistent followup orthopedic visits also had consistent followup radiographs over 6 years. Multivariate analyses revealed that older patients were less likely to have radiographic followup than younger patients (OR 0.76, 95% CI 0.65, 0.89) per each 5-year increase in age. Subjects with no college education were less likely to have radiographic followup than those with more education (OR 0.58, 95% CI 0.41, 0.83), and those with lower income were less likely to have radiographic followup than those with a higher income (OR 0.50, 95% CI 0.27, 0.92). Conclusion. Only 42% of THR recipients reported consistent radiographic followup. Older patients, patients with lower income, and those with lower education level were less likely to have consistent radiographic followup over 6 years after THR. These population groups can serve as targets for interventions to improve followup after elective THR. (J Rheumatol 2006;33:1159–66) Key Indexing Terms:
TOTAL HIP REPLACEMENT
From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences; and Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School; Department of Biostatistics, Boston University School of Public Health; Department of Medicine, Boston University Medical School; Department of Orthopedic Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; and Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire, USA. Supported by NIH Grants P01 AR47782 and K24 AR02123, AHRQ Grant 1R01 HS09775-01, and a Clinical Science Grant from the Arthritis Foundation. Dr. de Pablo was supported by a Post Doctoral Fellowship from the Arthritis Foundation. P. de Pablo, MD, MPH, Post-doctoral Fellow; A.H. Fossel, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School; E. Losina, PhD, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Assistant Professor of Biostatistics, Department of Epidemiology and Biostatistics, Boston University School of Public Health and Department of Medicine, Boston University Medical School; N. Mahomed, MD, ScD, Associate Professor of Orthopedic Surgery, Department of Orthopedic Surgery, Toronto Western Hospital, University of Toronto; J. Wright, MD, Assistant Professor of Orthopedic Surgery, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School; J.A. Barrett, MS, Assistant Research Professor, Department of Community and Family Medicine, Dartmouth Medical School; J.N. Katz, MD, MS, Assistant Professor of Medicine and Orthopedic Surgery, Division of Rheumatology, Immunology and Allergy, Department of Medicine, and Department of Orthopedic Surgery Brigham and Women's Hospital, Harvard Medical School. Address reprint requests to Dr. J.N. Katz, Section of Clinical Sciences, Division of Rheumatology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail: jnkatz@partners.org Accepted for publication January 26, 2006.
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