Comparative effectiveness of alternative clinical pathways for primary hip and knee joint replacement patients: a pragmatic randomized, controlled trial

3434 patients with a degenerative joint disorder who received THR or TKR during the time frame of the study were randomized to undergo a new clinical pathway (NCP) or the standard of care (SOC). Over 12 months, the NCP group demonstrated significantly greater improvement than the SOC group in Western Ontario and McMaster University Osteoarthritis Index (WOMAC) overall score. There was also greater improvement in the SF-36 bodily pain score in the NCP group; however, there was no significant difference between the two groups for SF-36 physical function scores. The results from the study therefore suggest that the new clinical pathway is effective in reducing pain and increasing function. However, even though the results indicate positive results using NCP, the large loss to follow-up calls these finding into question.