Quantifying Clinical Encounters for Orthopaedic Hip and Knee Surgeries: A Retrospective Analysis of Provider Workload
Document Type
Article
Publication Date
2-2-2026
Institution/Department
Orthopedics
Journal Title
The Journal of arthroplasty
Abstract
BACKGROUND: The time spent providing postoperative care for total hip arthroplasty (THA) and total knee arthroplasty (TKA) has increased provider workload, drawing attention to the Relative Value Scale Update Committee's (RUC) current estimation of work relative value units. Our aim for this study was to quantify the postoperative work performed by the surgeon and their team for THA and TKA during the 90-day global period. We hypothesized that the work intensity and time spent on postoperative communication were higher than estimated by current work relative value units. METHODS: We retrospectively evaluated all patients undergoing primary total joint arthroplasty at our institution between January 1, 2019, and December 31, 2024. Primary outcomes included the number of postoperative interactions from discharge to 90 days after surgery. These included office visits, telehealth visits, phone calls, and patient portal messages. RESULTS: From 2019 to 2024, the average number of postoperative total joint arthroplasty interactions per patient increased across all modalities. Telephone encounters spiked during the coronovirus disease 2019 pandemic and remain elevated, while portal messages rose more than fivefold. Office visits averaged 2.3 per patient, exceeding the two currently recognized in RUC valuations. Administrative tasks and telehealth also showed steady annual growth. Meanwhile, hospital lengths of stay decreased from 44.5 hours in 2018 to 32.6 hours in 2022. These findings highlight a shift of postoperative care from institutional settings to surgeon offices and virtual platforms. CONCLUSIONS: Over the past five years, postoperative care for THA and TKA has increasingly relied on surgeon teams, resulting in a measurable rise in office visits, virtual encounters, and administrative messaging not reflected in current RUC valuations. With declining physician reimbursement, these findings underscore the need to update valuation models to capture the true scope of postoperative care in current joint arthroplasty practice.
Recommended Citation
Rana, Adam J.; Sewell, Janel K.; Sirisoma, Amanda V.; Walsh, Zoë A.; Faour, Kamli N.; and McGrory, Brian J., "Quantifying Clinical Encounters for Orthopaedic Hip and Knee Surgeries: A Retrospective Analysis of Provider Workload" (2026). MaineHealth Maine Medical Center. 4347.
https://knowledgeconnection.mainehealth.org/mmc/4347
