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.
Smith, L., Powell, J., Dures, E., Palmer, S., Lenguerrand, E., Beswick, A., & Blom, A. (2019). Hip arthroplasty surveillance: Is it really needed?