Primary Care Research

Followup care after total hip replacement could be improved

Less than half of individuals who undergo total hip replacement (THR) receive followup radiography within 6 years after the operation, according to a new study. Radiography can detect osteolysis, a progressive inflammatory reaction to the hip prosthesis, which can lead to destruction of bone and need for revision THR. While osteolysis is typically painful in its later stages, when it causes substantial loosening of the prosthesis, the early phases of osteolysis are generally asymptomatic. Radiography can detect osteolysis early so that monitoring and therapy can help delay or prevent the need for more complex revision surgery.

However, researchers found that less than half of elderly adults who underwent THR had consistent radiographic followup. The researchers analyzed Medicare claims data to identify a group of 622 elderly patients in 3 states (Ohio, Pennsylvania, and Colorado), who received elective primary THR in 1995. They surveyed the patients 3 and 6 years after the surgery. Overall, 15 percent of patients had no followup radiographs, 43 percent had early followup only, and 42 percent had consistent followup radiographs over 6 years.

After accounting for other factors, older patients were 24 percent less likely to have radiographic follow up than younger patients per each 5-year increase in age. Patients with no college education were 42 percent less likely to have radiographic followup than those with more education, and those with lower income were 50 percent less likely to have followup than those with a higher income. These groups should be targeted for interventions to improve followup after elective THR, suggest the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS09775).

See "Extent of followup care after elective total hip replacement," by Paola de Pablo, M.D., M.P.H., Elena Losina, Ph.D., Nizar Mahomed, M.D., Sc.D., and others in the June 2006 Journal of Rheumatology 33, pp. 1159-1166.

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