The potential for response bias in the reporting of patient satisfaction, function, and knee scores when using email or telephone surveys is a legitimate concern [26, 27, 34, 35]. But while there are potential inaccuracies of the questionnaires that are used for assessing clinical outcome and patient satisfaction, as well as a variety of other objective measurements, questionnaires can be a valuable vehicle for identifying symptoms of failure of knee arthroplasties that have previously been functioning well [24, 30]. While these clues to failure should theoretically be easily gleaned from a questionnaire, there is an element of diminished efficacy of email-based surveys. One recent survey of 472 surviving patients after total knee arthroplasty found that the response to questionnaires tends to diminish with time from the index surgery, such that the response rate to a standard questionnaire fell from 75% at 2 years to 54% at 10 years (p = 0.0016) [28]. In that series, “nonresponders” tended to be those with inferior results; however, the study did not identify whether those who had new signs of problems were more or less likely to respond to the questionnaire than those who were faring well or those who had never done well after the surgery [27].

Nonetheless, as an alternative to office-based follow-up visits after the first postoperative year, web-based follow-up of knee and hip arthroplasty is cost-effective, time efficient, and a safe method of follow-up inasmuch as identifying problems or concerns that should prompt an in-person physician visit. While 14% of patients may prefer to see the surgeon in person, others prefer the convenience and lower costs associated with web-based follow-up [30]. In a study by Marsh et al., while moderate to high satisfaction levels with a web-based follow-up assessment have been reported, patients who completed the usual method of in-person follow-up assessment reported greater satisfaction (82% vs. 76%). However, the small difference in satisfaction may not outweigh the additional cost and time-saving benefits of the web-based follow-up method [29]. Additionally, Marsh et al. reported substantial cost savings from a societal and healthcare payer perspective with web-based follow-up, making its use particularly germane given cost pressures in contemporary healthcare [28].