The association between lost to follow-up and patient reported outcomes two years following total knee replacement, a single center study.

Abstract

BackgroundTotal knee arthroplasty (TKA) is among the most frequently performed orthopedic procedures worldwide. Postoperative outcomes are commonly assessed through routine clinical follow-up; however, a substantial proportion of patients do not adhere to scheduled visits and are classified as lost to follow-up (LFU). Data regarding patient-reported outcomes in this population remain limited and conflicting.MethodsThis retrospective, single-center cohort study included patients aged ≥50 years who underwent primary TKA between January 2018 and March 2020, allowing for a minimum follow-up of 2 years. Patients who attended one or no routine postoperative clinic visits during the first postoperative year were classified as LFU and compared with patients who attended two or more visits (FU). At least 2 years postoperatively, patients completed the Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and a numeric rating scale for pain. Group comparisons were performed using Wilcoxon rank-sum test and independent-samples. Multivariable logistic regression analyses assessed associations between patient-reported outcomes and loss to follow-up while adjusting for age, sex, body mass index, ethnicity, and Charlson Comorbidity Index (CCI).ResultsA total of 250 patients were included, of whom 63 (25.2%) were classified as LFU. Patients in the LFU group demonstrated significantly higher OKS and KOOS scores and lower pain scores compared with the FU group. Multivariable analyses confirmed that higher functional scores and lower pain levels were independently associated with loss to follow-up.ConclusionsPatients lost to routine postoperative follow-up after TKA reported superior functional outcomes and lower pain levels. These findings suggest that favorable recovery may reduce the perceived need for continued follow-up, with implications for optimizing postoperative surveillance strategies.