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Systematic review of the clinical effectiveness for long-term follow-up of total hip arthroplasty

Smith, Lindsay K.; Dures, Emma; Beswick, Andrew

Authors

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Lindsay Smith Lindsay6.Smith@uwe.ac.uk
Senior Lecturer in Physiotherapy (Academic Clinical Research)

Emma Dures Emma2.Dures@uwe.ac.uk
Associate Professor in Rheumatology and Self-management

Andrew Beswick andy.beswick@bristol.ac.uk



Abstract

Objectives
Total hip arthroplasty (THA) is highly successful but national registries indicate that average age has lowered and that younger patients are at higher risk of revision. Long-term follow-up of THA was historically recommended to identify aseptically failing THA, minimising the risks associated with extensive changes, but follow-up services are now in decline. A systematic review was conducted to search for evidence of the clinical or cost-effectiveness of hip arthroplasty surveillance.

Methods
The study was registered with PROSPERO International Prospective Register of Systematic Reviews and conducted according to PRISMA guidelines; databases included MEDLINE and Embase, and all studies were quality assessed. Original studies (2005 to 2017) reporting follow-up of adults with THA in situ >5 years were included. Researchers extracted quantitative and qualitative data from each study.

Results
4137 studies were screened for eligibility: 114 studies were included in final analysis, representing 22 countries worldwide. Data extracted included study endpoint, patient detail, loss to follow-up, revisions, scores and radiographic analysis. Six themes were derived from inductive content analysis of text: support for long-term follow-up, subgroups requiring follow-up, effect of materials/techniques on THA survival, effect of design, indicators for revision, review process. 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.
Outcome scores alone are not enough, and radiographic review should be included.

Conclusions
There were no studies directly evaluating the clinical effectiveness of the long-term follow-up of THA but expert opinion from a range of international authors advocated its use for defined subgroups to provide patient-centred care. In the absence of higher level evidence, these opinions in conjunction with emerging outputs from the national joint registries should be used to inform services for long-term follow-up of THA.

Citation

Smith, L. K., Dures, E., & Beswick, A. (2019). Systematic review of the clinical effectiveness for long-term follow-up of total hip arthroplasty. Orthopedic Research and Reviews, 11, 69-78. https://doi.org/10.2147/ORR.S199183

Journal Article Type Review
Acceptance Date Mar 20, 2019
Online Publication Date Jul 2, 2019
Publication Date Jul 2, 2019
Journal Orthopedic Research and Reviews
Electronic ISSN 1179-1462
Publisher Dove Medical Press
Peer Reviewed Peer Reviewed
Volume 11
Pages 69-78
DOI https://doi.org/10.2147/ORR.S199183
Keywords hip joint, replacement, surveillance, revision, continuing
Public URL https://uwe-repository.worktribe.com/output/1493763
Publisher URL http://www.dovepress.com/

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