Routine follow up of asymptomatic primary total hip arthroplasties: Need for revision surgery

Hacking, Craig, Weinrauch, Patrick C., Whitehouse, Sarah, Crawford, Ross W., & Donnelly, William J. (2007) Routine follow up of asymptomatic primary total hip arthroplasties: Need for revision surgery. In Australian Orthopaedic Association Queensland Branch Meeting, 8 - 11 June, 2007, Townsville, Queensland Australia.

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The objective of routine outpatient assessment of well functioning patients after primary total hip arthroplasty (THA) is to detect asymptomatic failure of prostheses to guide recommendations for early intervention. In a tertiary referral arthroplasty centre, conducting approximately 250 primary THAs and 50 Revision THAs per annum, we have observed that the revision of THAs in asymptomatic patients is a very uncommon occurrence. We therefore question the requirement for routine follow-up of asymptomatic patients after THA.

Following Ethics approval, a prospective analysis of an orthopaedic database identified 158 patients whom received 177 revision THAs over a 4 year period. A retrospective chart review was conducted patients whom met the inclusion criteria. Patient demographics, primary and revision surgery parameters and follow-up information was recorded and analysed. Data was cross referenced with Australian Orthopaedic Association National Joint Replacement Registry data. No direct recruitment or patient contact was undertaken and all patient information was de-identified.

One hundred and thirteen revision of primary THAs in 107 patients (61 males (55.5%) and 49 females (44.5%), combined average age 70.4 ± 9.80 years) met the inclusion criteria. There were 70 (63.6%) total, 13 (11.8%) femoral and 27 (24.5%) acetabular revisions. The main indications for revision surgery were aseptic prosthetic loosening (70%), hip dislocation (8.2%), femoral peri-prosthetic fracture (6.4%), osteolysis (6.4%) and joint infection (4.5%). Only 6 (5.5%) of the revision THAs were asymptomatic revisions. A mean of 5.3 ± 5.2 and 1.9 ± 5.3 follow-up appointments were required before revision in patients with and without symptoms, respectively. In asymptomatic patients, a mean of 5.3 ± 5.2 follow-up appointments were required before revision. In symptomatic patients, a mean of 1.9 ± 5.3 follow-up appointments were required before revision. The average time from the primary to revision surgery was 11.8 ± 7.23 years.

We hypothesise that for patients with prostheses with excellent long term clinical results as validated by Joint Registries, routine follow-up of asymptomatic THA should be questioned and requires further investigation. Based on the work of this study, the current practice of routine follow-up of asymptomatic THA may be excessively costly and unnecessary and a less resource-intensive review method may be more appropriate.

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ID Code: 8360
Item Type: Conference Paper
Refereed: Yes
Additional URLs:
Keywords: Hip, Revision, Arthroplasty
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > CLINICAL SCIENCES (110300) > Orthopaedics (110314)
Divisions: Past > QUT Faculties & Divisions > Faculty of Built Environment and Engineering
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2007 The Authors
Deposited On: 02 Jul 2007 00:00
Last Modified: 10 Aug 2011 14:27

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