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Mid-to late-term follow-up of primary hip and knee arthroplasty: the UK SAFE evidence-based recommendations

Kingsbury, Sarah R.; Smith, Lindsay K. K.; Pinedo-Villanueva, Rafael; Judge, Andrew; West, Robert; Wright, Judy M.; Stone, Martin H.; Conaghan, Philip G.

Mid-to late-term follow-up of primary hip and knee arthroplasty: the UK SAFE evidence-based recommendations Thumbnail


Sarah R. Kingsbury

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Dr Lindsay Smith
Senior Lecturer in Physiotherapy (Academic Clinical Research)

Rafael Pinedo-Villanueva

Andrew Judge

Robert West

Judy M. Wright

Martin H. Stone

Philip G. Conaghan


Aims To review the evidence and reach consensus on recommendations for follow-up after total hip and knee arthroplasty. Methods A programme of work was conducted, including: a systematic review of the clinical and cost-effectiveness literature; analysis of routine national datasets to identify pre-, peri-, and postoperative predictors of mid-to-late term revision; prospective data analyses from 560 patients to understand how patients present for revision surgery; qualitative interviews with NHS managers and orthopaedic surgeons; and health economic modelling. Finally, a consensus meeting considered all the work and agreed the final recommendations and research areas. Results The UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE) recommendations apply to post-primary hip and knee arthroplasty follow-up. The ten-year time point is based on a lack of robust evidence beyond ten years. The term 'complex cases' refers to individual patient and surgical factors that may increase the risk for arthroplasty failure. For Orthopaedic Data Evaluation Panel (ODEP) 10A* minimum implants, it is safe to disinvest in routine follow-up from one to years post-non-complex hip and knee arthroplasty provided there is rapid access to orthopaedic review. For ODEP 10A* minimum implants in complex cases, or non-ODEP 10A* minimum implants, periodic follow-up post-hip and knee arthroplasty may be required from one to ten years. At ten years post-hip and knee arthroplasty, clinical and radiological evaluation is recommended. After ten years post-hip and knee arthroplasty, frequency of further follow-up should be based on the ten-year assessment; ongoing rapid access to orthopaedic review is still required. Conclusion Complex cases, implants not meeting the ODEP 10A* criteria, and follow-up after revision surgery are not covered by this recommendation.


Kingsbury, S. R., Smith, L. K. K., Pinedo-Villanueva, R., Judge, A., West, R., Wright, J. M., …Conaghan, P. G. (2023). Mid-to late-term follow-up of primary hip and knee arthroplasty: the UK SAFE evidence-based recommendations. Bone & Joint Open, 4(2), 72-78.

Journal Article Type Article
Acceptance Date Jan 6, 2023
Publication Date Feb 3, 2023
Deposit Date Mar 7, 2023
Publicly Available Date Mar 8, 2023
Journal Bone and Joint Open
Electronic ISSN 2633-1462
Publisher British Editorial Society of Bone and Joint Surgery
Peer Reviewed Peer Reviewed
Volume 4
Issue 2
Pages 72-78
Keywords Surgery, Orthopedics and Sports Medicine
Public URL
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