Implementation and Evaluation of a Remote, Questionnaire-Based Model for Monitoring Patients Following Hip or Knee Replacement Surgery.

Background: The benefits of long-term follow-up of patients following hip and knee joint replacement surgery are currently debated. This study evaluated a questionnaire-based model for remotely monitoring patients. Primary outcomes included response rates, acceptability to patients, and whether remote review identified patients requiring reoperation. Methods: Data were collected over a 7-year period from a large regional teaching hospital in Australia. Hard-copy questionnaires were sent to patients at 1, 5, and 8 years after joint replacement and biennially thereafter. The questionnaire assessed whether patients had pain or concerns regarding their joint replacement and whether orthopedic review was requested. Response rate was determined as the proportion of patients who returned the questionnaire and was considered acceptable if it was not significantly lower than the proportion of patients who attended a 1-year in-person appointment in the 3 years prior to introducing remote-review. Patient preferences for remote versus in-person review were collected from a subgroup of patients (n = 488) using an investigator-designed questionnaire. All reoperations during the study period were examined to determine if they were first identified via the remote-review questionnaire. Results: The response rate at 1 year was 69.3% (2,266 responses from 3,268 questionnaires sent), which was significantly lower than historical in-person outpatient attendance rates (82.7%, p < 0.001). A majority of patients (62.1%) preferred remote follow-up to in-person review. Of the 116 reoperations that occurred during the study period, remote review identified 5 patients, representing 0.1% of questionnaire responses. Most complications requiring reoperation were first identified via emergency departments (56.9%) or general practice (31.9%). Conclusions: While remote review following joint replacement surgery was consistent with most patients' preferences for follow-up care, response rates were lower than historical attendance rates for in-person outpatient appointments. Routine remote review was an inefficient mechanism for identifying complications requiring reoperation, most of which were first identified via emergency departments and general practice.