Hip arthroplasty surveillance: Is it really needed?

Smith, Lindsay; Powell, Jane; Dures, Emma; Palmer, Shea; Lenguerrand, Erik; Beswick, Andrew; Blom, Ashley

Abstract

Abstract for BOA 2019
Although long-term follow up of joint replacement is advocated, in a national audit of 42 orthopaedic units, only 43% were continuing follow up beyond 5 years. Four studies were conducted using mixed methods research to address the following question: Hip arthroplasty surveillance: Is it really necessary?

1. Systematic literature review: explored evidence for clinical or cost effectiveness of long-term hip arthroplasty surveillance. 114 studies were included, but due to paucity of quantitative evidence related to the research question, qualitative techniques were used to examine expert opinion. Main findings - follow up was specifically recommended to monitor change (e.g. asymptomatic loosening), when outcomes of joint construct are unknown, and for specific patient subgroups.
2. Pilot observational study: cohort of patients undergoing revision hip arthroplasty. Baseline PROMS were collected and repeated 12 months after surgery plus health resource use in the 6 months after surgery. Results indicate that patients with follow up report a better view of health than those without 12 months after surgery, and less health resources are used in the group with follow-up.
3. Survey of health professionals: to find out current views on long-term follow-up (172 participants). 87% in favour of long-term surveillance, although 33% preferred change in time intervals and methods of delivery.
4. Patient focus groups: to find out patient view. They prefer questionnaires based on everyday life (postally or electronically), an x-ray (preferably locally), would accept a letter stating results but want periodic review with orthopaedics. All wanted telephone access back-up to orthopaedic team. They stated - no exclusions - age is not determinant of health and questionnaires can act as a self-exclusion tool.

These studies suggest that some long-term follow-up is consistent with patient-centred care but needs to be delivered using effective and timely methods which can respond to evidence emerging from orthopaedic registries.

• Presentation Conference Type: Conference Paper (published)
• Conference Name: British Orthopaedic Association Annual Congress 2019
• Start Date: Sep 10, 2019
• End Date: Sep 13, 2019
• Acceptance Date: May 22, 2019
• Publication Date: Sep 10, 2019
• Deposit Date: Feb 10, 2020
• Public URL: https://uwe-repository.worktribe.com/output/4557926
• Publisher URL: https://www.boa.ac.uk/annual-congress/annual-congress-2019-liverpool.html