Evidence-based follow-up recommendations following primary hip and knee replacement (UK SAFE)

Smith, Lindsay; Stone, Martin; Kingsbury, Sarah; Czoski-Murray, Carolyn; Judge, Andrew; Pinedo-Villanueva, Rafael; West, Robert; Wright, Judy; Smith, Chris; Arden, Nigel; Conaghan, Philip

Abstract

Background:
Follow-up of arthroplasty varies widely across the UK. The aim of this NIHR-funded study was to employ a mixed-methods approach to examine the requirements for arthroplasty follow-up and produce evidence-based and consensus-based recommendations. It has been supported by BHS, BASK, BOA, ODEP and NJR.

Methods: Four interconnected work packages were undertaken: (1) a systematic literature review; (2a) analysis of routinely-collected National Health Service data from four national datasets to understand when and which patients present for revision surgery; (2b) prospective data regarding how patients currently present for revision surgery; (3) economic modelling to simulate long-term costs and quality-adjusted life years associated with different follow-up care models and (4) a Delphi- consensus process, involving all stakeholders, to develop a policy document to guide appropriate follow-up care after primary hip and knee arthroplasty.

Results:
The following Recommendations were agreed:
• For ODEP10A* minimum implants, it is safe to disinvest in routine follow-up from 1 to 10 years post non-complex hip and knee replacement provided there is rapid access to orthopaedic review
• For ODEP10A* minimum implants in complex cases, or non-ODEP10A* minimum implants, periodic follow-up post hip and knee replacement may be required from 1 to 10 years
• At 10 years post hip and knee replacement, we recommend clinical, which may be virtual, and radiographic evaluation.
• After 10 years post hip and knee replacement, frequency of further follow-up should be based on the 10 year assessment; ongoing rapid access to orthopaedic review is still required

Conclusions and Implications:
These recommendations apply to post primary hip and knee replacement follow-up.
The 10-year time point in these recommendations is based on a lack of robust evidence beyond ten years. The term complex cases refer to individual patient and surgical factors that may increase the risk for replacement failure.

• Presentation Conference Type: Conference Paper (unpublished)
• Conference Name: British Orthopaedic Association Virtual Congress 2020
• Start Date: Sep 14, 2020
• End Date: Sep 25, 2020
• Deposit Date: Oct 27, 2020
• Public URL: https://uwe-repository.worktribe.com/output/6729109
• Publisher URL: https://www.boa.ac.uk/pre-recorded-webinars/recorded-live-sessions.html
• Additional Information: Podium presentation of Abstract No. 512 in Free Papers - Hips on Thursday 24th September 2020