Osteoarthritis is one of the most common conditions seen and treated by orthopaedic surgeons worldwide. With mean life expectancy continuing to increase and an ongoing obesity epidemic, the incidence of osteoarthritis is only expected to increase in the future. Total joint arthroplasty is a cost-effective procedure to reduce pain and improve function in patients with advanced osteoarthritis. However, with the increasing demand for this procedure, wait times for the surgery continue to increase. It is projected that approximately 4 million total hip and knee arthroplasties will be performed per year in the United States alone by the year 2030. This increase is associated with an overall increase in health-care costs.

In their study, Marsh et al. aimed to compare the cost-effectiveness of web-based follow-up after total joint arthroplasty with that of in-person follow-up. They randomized 229 patients to receive one of these two methods of follow-up and recorded travel costs, time required by the patient, and resource use during the first year of follow-up. They performed a cost analysis from the payer (Ontario Ministry of Health and Long-Term Care) perspective and also from the societal perspective. They reported several important findings.

First, they found a reduction in costs (reported in Canadian dollars) from the payer perspective for the patients who received web-based follow-up ($159) compared with in-person follow-up ($185), although the difference was not significant. In light of the recent changes in the United States health-care system, cost-effectiveness and decreasing overall health care-costs are becoming increasing priorities. The results of this study are encouraging and could certainly affect clinical practice, not only in Canada and the United States but all over the world. Especially in countries with a more socialized health-care system (e.g., in parts of Europe), cost-efficiency is a major focus in health care as the discrepancy between supply and demand can lead to an increase in wait times for patients.

Careful monitoring of patients with total joint implants is important in both the short and long term. Therefore, reducing the number of follow-up appointments or the length of follow-up is not an option. Even several years after the index procedure, patients continue to be at risk for periprosthetic joint infection, implant wear, loosening, and catastrophic failure. Meding et al.reviewed the outcomes of 16,414 primary total knee arthroplasties to determine the time to reoperation for specific failure mechanisms. The median times to failure for the most common failure mechanisms were 1.9 years for infection, 3.1 years for tibial collapse, 4.9 years for implant loosening, and 5.6 years for instability.