Is long-term follow-up after uncomplicated primary total hip arthroplasty necessary?

Background BOA Guidelines recommend clinical and radiological follow-up after primary total hip arthroplasty (THA) at 1 and 5 years, and every 5 years thereafter to detect asymptomatic failure and allow early intervention. As revision surgery in asymptomatic patients is rare the need for routine follow-up in well-functioning individuals has recently been questioned. To evaluate the role of routine follow-up out-patient appointments (OPA) in identifying failing implants the modes of presentation for patients undergoing revision THA were reviewed. Methods 176 patients who received 183 revision THAs (2003–2010) were identified from an arthroplasty database. 124 patients who received 131 first time revision THAs after primary cemented total hip arthroplasty met inclusion criteria. Retrospective notes review was performed to investigate symptoms at failure and mode of presentation. Results Most patients were seen as referrals from other specialities. Only 25% were detected via routine follow-up OPAs. The mode of initial presentation was GP 60%, routine orthopaedic OPA 25%, A&E 9%, hospital inpatient 4%, rheumatology 2%. No patients were asymptomatic. Predominant symptoms were pain 99%, impaired mobility 80%, limp 44%, stiffness 25%, night pain 22%, systemic symptoms 8%. Estimated minimum cost of routine OPA was £35. For the 377 primary THRs performed in 2009 the saving at one year with discharge after 3months would be £13149. Assuming mean 15 year survival £52780 would be saved over the cohort lifespan. Conclusions Following uncomplicated primary cemented THA with our combination of polished tapered stem and flanged cup failure is unlikely to occur without symptoms. Symptomatic patients present mainly via their GP and other specialities and are mostly seen as new or re-referrals rather than being detected via routine OPAs. With appropriate advice, discharge after the earliest clinic when the patient has returned to full normal activities is potentially safe and could lead to significant savings.