1. Radiographic follow up of hip and knee arthroplasty
D Matthews, S Gulhane, F S Haddad ISTA 3-6 October 2012, Sydney
Background:
Arthroplasty effectively relieves pain
Increasing numbers of procedures performed each year
Limited lifespan of implants
No formal guidelines for follow up
Causes of implant failure:
Dislocation
Deep infection
Malposition/impingement
Peri-prosthetic fracture
ALVAL
Metalosis
Aseptic loosening/osteolysis
Early
Follow up - current practice:
Outpatient clinic follow up
Utilizes time and money with low pick up rates
Symptomatic patients could be screened with questionnaires
Plain radiographs
BOA recommend AP and lateral every 5 years for TKA
BOA recommend radiographs at 1 year, 5 years and each 5 years thereafter for THA
Absence of radiolucencies 100% sensitive and 45% specific in predicting no need for revision in first 10 years
Early complications present with symptomatic patients - rarely diagnosed radiographically in “well” patients
CT, MRI, PET, DEXA
Expensive and time consuming
Unnecessary for routine follow up in most cases
Late
Discussion:
Low patient scores on satisfaction and function questionnaires shown to be related to higher risk of revision
Patients could be stratified into low-risk and high-risk groups
Follow up arranged depending on results with high-risk patients reviewed yearly
Plain radiographs within first 5 years unlikely to reveal pathology if patient asymptomatic
Excluding initial post-operative radiograph
Radiographs at 2 yearly intervals until 10 years are likely to be sufficient when combined with patient questionnaires
Reduces busy outpatient clinics and associated cost of reviewing asymptomatic patients
References:
Bannister G, Ahmed M, Bannister M, Bray R, Dillon P, Eastaugh-Waring S. Early complications of total hip and knee replacement: a comparison of outcomes in a regional orthopaedic hospital and two independent treatment centres. Ann R Coll Surg Engl. 2010;92:610-4
Haddad FS, Ashby E, Konangamparambath S. Should follow-up of patients with arthroplasties be carried out by general practitioners? J Bone Joint Surg Br. 2007:1133-4
Kurtz S, Ong K, Lau E, Mowat F,Halpern H. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to J Bone Joint Surg Am 2007;89:780-5
Rothwell AG, Hooper GJ, Hobbs A, Frampton CM. An Analysis of the Oxford hip and knee scores and their relationship to early joint revision in the New Zealand Joint Registry. J Bone Joint Surg Br 2010;92(3):413-8
Sheikh A, Schweitzer M. Pre- and postoperative assessment in joint preserving and replacing surgery. Rheum Dis Clin North Am. 2009;35:651-73
Teeny SM, York JSC, Mesko W, Rea RE. Long-term follow up care recommendations after total hip and knee arthroplasty: results of the American Association of Hip and Knee Suregon’s member survey. J Arthroplasty 2003;954-62