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Loss to follow-up matters

D W Murray1, A R Britton, C J Bulstrode

  • 1The Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Headington, England.

The Journal of Bone and Joint Surgery. British Volume
|March 1, 1997
PubMed
Summary

Patients lost to follow-up after total hip replacement surgery experience worse outcomes. Survival analysis ignoring this loss may yield falsely optimistic results, highlighting the need to minimize patient attrition.

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Area of Science:

  • Orthopedic Surgery
  • Biostatistics
  • Clinical Trial Methodology

Background:

  • Survival analysis in joint replacement studies assumes lost patients have outcomes similar to assessed patients.
  • This assumption is critical for the validity of long-term joint replacement outcome data.
  • Patient attrition can significantly bias the interpretation of surgical success rates.

Purpose of the Study:

  • To evaluate the outcomes of patients lost to follow-up after total hip replacement.
  • To determine if patients lost to follow-up differ significantly from those retained.
  • To assess the impact of patient loss on the accuracy of survival analysis in joint replacement.

Main Methods:

  • Retrospective analysis of 2268 total hip replacement patients over a 16-year period.
  • Comparison of clinical and radiological outcomes between patients lost to follow-up and a matched control group.
  • Calculation of cumulative loss to follow-up rates and introduction of a loss-to-follow-up quotient.

Main Results:

  • 142 patients (6%) were lost to follow-up over 16 years, with a cumulative loss reaching 20% at 15 years.
  • Patients lost to follow-up exhibited significantly worse pain, reduced range of motion, poorer self-reported progress, and adverse radiological findings compared to controls (p < 0.001 and p < 0.01).
  • These findings indicate that patients lost to follow-up have poorer outcomes.

Conclusions:

  • Survival analyses that do not account for patients lost to follow-up are likely to produce falsely optimistic results.
  • Minimizing loss to follow-up through vigorous efforts is essential for reliable joint replacement outcome studies.
  • The rate of loss to follow-up and a loss-to-follow-up quotient are crucial metrics for assessing study reliability.

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