Is routine mid-term total hip arthroplasty surveillance beneficial?
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.


OBJECTIVE
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.


RESULTS
Fifty-three percent of patients returning for routine followup had no symptoms, 31% reported an unrelated musculoskeletal concern, and 19% had symptoms from their primary THA (15%) or revision THA (32%). Sixty-nine percent of symptomatic patients and 10% of asymptomatic patients received treatment recommendations, with physical therapy as the most frequent intervention (74%). Revision surgery was recommended for 6% of symptomatic and 0.6% of asymptomatic patients.


CONCLUSIONS
Although routine surveillance may identify rare, asymptomatic patients with arthroplasty failure, it is much more likely to result in recommendations for nonoperative management during early followup.


METHODS
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Suite 11300 West Pavilion, Campus Box 8233, St Louis, MO 63110, USA. keeneyj@wudosis.wustl.edu
James A
JA
Keeney
Bradley S
BS
Ellison
William J
WJ
Maloney
John C
JC
Clohisy
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult