Is Routine Mid-term Total Hip Arthroplasty Surveillance Beneficial?

Abstract

Background Routine followup of patients after primary or revision THA is commonly practiced and driven by concerns that delays in identifying early failure will result in more complicated or more costly surgical interventions. Although mid-term followup (4-10 years) has been performed to follow cohorts of patients, the benefit of observing individual patients regardless of symptoms has not been established. Questions/purposes We determined (1) the reasons patients with THA return for mid-term followup, (2) the treatment recommendations and interventions occurring as a result of mid-term followup, and (3) how frequently revision surgery is recommended for asymptomatic and symptomatic patients at mid-term followup. Methods We retrospectively identified 501 patients (503 hips) who returned for followup at least 4 years (mean, 5 years; range, 4-10.9 years) after their primary or revision THA. We recorded their reasons for followup and treatment recommendations, including those for revision surgery, at mid-term followup.

A Survey of the Current State of Hip Arthroplasty Surveillance in the United Kingdom

“…The selection of patients by age was implemented in 14% of the units, as advised in recent guidelines, which state that surveillance should be targeted at those aged 65 years or less at primary surgery (British Orthopaedic Association, ). Although age is not a predictive variable for radiographic changes around a hip arthroplasty at mid‐term, the reduction of mechanical demand on a joint and the increased risk of comorbidities lessen the likelihood of revision (Wainwright et al, ; Keeney et al, ; Smith et al, ). Low rates of non‐attendance for arthroplasty surveillance have been reported elsewhere and imply that these services are well received by patients, although further research is needed to explore the patient perspective (Teo and Smith, ).…”

“…Despite the improvement to materials used in total hip arthroplasty, osteolysis continues to be a threat to the survival of the joint, and follow‐up is advocated (Beck et al, ). Some authors suggest that age should determine follow‐up – that is, that younger, active patients should receive more frequent follow‐up and that patients in their mid‐70s at primary surgery do not require any routine surveillance (Wainwright et al, ; Keeney et al, ). The time intervals necessary for effective arthroplasty surveillance are unclear but many authors now suggest that review before seven years is unnecessary, other than routine early checks (Bolz et al, ; Keeney et al, ; Malchau et al, ).…”

“…Some authors suggest that age should determine follow‐up – that is, that younger, active patients should receive more frequent follow‐up and that patients in their mid‐70s at primary surgery do not require any routine surveillance (Wainwright et al, ; Keeney et al, ). The time intervals necessary for effective arthroplasty surveillance are unclear but many authors now suggest that review before seven years is unnecessary, other than routine early checks (Bolz et al, ; Keeney et al, ; Malchau et al, ). The recent UK guidelines emphasize the importance of X‐ray images and their interpretation as part of the follow‐up, in conjunction with patient‐reported outcome measures (British Orthopaedic Association, ).…”

Robots in orthopaedics

“…9 They will then have more time to master accurate joint replacement, whether free-hand or assisted, and to increase their volume.…”

<p>Systematic review of the clinical effectiveness for long-term follow-up of total hip arthroplasty</p>

“…For many people, total hip arthroplasty (THA) is successful for treating a painful, arthritic hip but national registries indicate that 10% of implants will subsequently require revision, which increases to 30% for those under 50 years old at primary surgery 1. Up to five years postoperatively, revision is predominantly undertaken for dislocation, infection or prosthetic failure,2–4 all of which present with pain. In the longer term, there is an increase in revision for aseptic loosening which can be asymptomatic and thus, surveillance offeres identification of a potential problem for these patients.…”