Clinical and cost effectiveness of hip arthroplasty surveillance

Hip arthroplasty continues to be a successful method for treating a painful hip with over 76,000 primary hip replacements recorded in the National Joint Registry of England Wales and Northern Ireland in the 2014 report (http://www.njrcentre.org.uk). Although the majority of patients will not require further treatment, approximately 10% will need a revision hip replacement. The national joint registries show that revision surgery in the early period, up to five years post operatively, is predominantly undertaken for dislocation, infection or prosthetic failure. These indications present with pain whereas in the period between five and ten years after the primary surgery, there is an increase of revision for aseptic loosening and, more recently, adverse reaction to metal debris. These later methods of failure of a hip arthroplasty are often asymptomatic in their early stages and are only identified if appropriate screening systems are in place. Although the Medicines and Healthcare Products Regulatory Agency publish a guideline for the review of all patients with metal on metal hip arthroplasty, there is no mandatory requirement for orthopaedic departments to follow up hip arthroplasty. The current economic evaluation of healthcare focuses on the provision of effective and efficient services and follow up of any patient group must be justified. Within orthopaedics, there is evidence that arthroplasty surveillance has been reduced. There have been suggestions that review of arthroplasty can be conducted by general practitioners without the need for orthopaedic input but the orthopaedic community strongly believes that there should be some form of surveillance in place for such patients. The main purpose of routine surveillance is to identify the aseptically failing hip arthroplasty when patients are often unaware of underlying changes or of the implications of any minor symptoms. Using systematic methods, we plan to examine the literature for evidence of clinical or economic effectiveness of orthopaedic follow up of hip arthroplasty