What Are the Migration Patterns for U.S. Primary Total Joint Arthroplasty Patients?

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Biostatistics

Background:

• Evaluating total joint arthroplasty (TJA) outcomes requires reliable procedure data.
• Patient migration can lead to loss to follow-up and inaccurate survivorship conclusions.
• The American Joint Replacement Registry (AJRR) aims for complete nationwide data capture.

Purpose of the Study:

• To quantify migration patterns of U.S. Medicare TJA patients.
• To identify demographic and institutional factors associated with patient migration.

Main Methods:

• Utilized Medicare fee-for-service records (2004-2015) for TJA procedures.
• Analyzed 1.38 million THAs and 3.03 million TKAs.
• Employed multivariate Cox models to assess migration risk factors.

Main Results:

• Within 5 years, 5.41% moved out-of-state and 5.50% moved out-of-county.
• Older patients (80+) and those with higher comorbidity scores were more likely to migrate.
• Women and Black patients showed different migration propensities compared to men and other racial groups.

Conclusions:

• Over 10% of Medicare TJA patients migrate within 5 years, impacting data completeness.
• Findings provide a "best-case" estimate of loss to follow-up.
• Reinforces the need for expanded AJRR hospital recruitment and future research on non-Medicare patients.