Hip arthoplasty surveillance: Is it really needed?

Smith, Lindsay K.

Abstract

Hip arthroplasty surveillance: Is it really needed?
Summary of presentation for Topic in Focus
Within the orthopaedic community, long-term follow up of joint replacement is recommended, a summary of which was included in the NICE guidelines in 2017 (due for update 2020). However, there has been evidence of the disinvestment in this practice, as shown by an audit of orthopaedic units in 2013, only 43% of which were continuing any follow up beyond 5 years. Within these units, 86% of the services were delivered by arthroplasty practitioners as part of the orthopaedic team.
A systematic literature review was conducted to explore evidence of the clinical or cost effectiveness of long-term hip arthroplasty surveillance. After reviewing over 4000 titles and abstracts, and including 114 studies, we were not able to find quantitative evidence to address the research question, but qualitative techniques were used to draw out the expert opinions contained within the studies. The main findings were that follow up was specifically recommended by these authors to monitor change, such as asymptomatic loosening, or when the outcomes of a joint construct are unknown, and for several patient subgroups.
The next question in which we were interested was: does long-term follow-up offer any benefit to patients around the time of revision surgery? We conducted a pilot observational study of a cohort of patients undergoing revision hip arthroplasty, collected baseline PROMS and repeated them 12 months after surgery, and collected data on health resources used in the first 6 months after surgery. The results indicate that those with follow up report a statistically significant better view of their general health (EQ-VAS) than those without 12 months after surgery, and that less health resources are used in the group with follow-up.
The next study was a survey of health professionals to find out their views on long-term follow-up. A survey of 172 participants at BASK and BHS in 2018 was conducted by questionnaire and showed that 87% were in favour of some form of follow-up, although 33% of the participants emphasised that some change was needed in the intervals and methods of delivery.
Finally, we conducted three focus groups to find out the patient view on long-term follow-up after hip arthroplasty. A range of patients were included and the key themes that have emerged relate to WHO, WHAT, WHEN, HOW follow up might be conducted. They stated that there should be no exclusions, as age is not determinant of health and that questionnaires can act as a self-exclusion tool – if not returned, no x-ray is ordered. They preferred that questionnaires were based on everyday life and functional activities, and wanted an x-ray, preferably locally. With regard to frequency, annually is too much; more than 3 years is too little. They repeatedly stated that they like to know they are still ‘in the system’. All were happy to receive a postal questionnaire, local x-ray and a letter to state results, but would want periodic review with orthopaedic personnel of at least senior registrar level or equivalent. Plus, all wanted telephone access to orthopaedic team, not their GP.
Lindsay K. Smith 26 February 2019

• Presentation Conference Type: Conference Paper (unpublished)
• Conference Name: British Hip Society Annual Scientific meeting 2019
• Start Date: Feb 27, 2019
• End Date: Feb 28, 2019
• Acceptance Date: Jan 20, 2019
• Publicly Available Date: Jul 15, 2019
• Peer Reviewed: Peer Reviewed
• Keywords: hip replacement, review, long-term, follow-up, research
• Public URL: https://uwe-repository.worktribe.com/output/1493915
• Additional Information: Additional Information : Invited lecture for Topic in Focus; Title of Conference or Conference Proceedings : British Hip Society Annual Scientific meeting 2019