Should primary care physicians perform routine long-term follow-up of total hip arthroplasty patients?

BackgroundIt has been suggested by some that follow-up of primary total hip arthroplasty (THA) patients should be performed by primary care physicians (general practitioners or GP’s in the UK), rather than by orthopaedic specialists. Such follow-up would, most likely, include radiographic follow-up based on review of radiographic reports.AimTo look at the quality of the radiographic reports to determine their usefulness as a method of radiographic follow-up of THAs.MethodsPre-revision radiographs of 50 patients were interpreted by a senior orthopaedic registrar, supervised by a consultant with a revision THA practice. This acted as the control against which the findings stated on the radiologist’s report of the same radiograph were compared. Signs of failure were categorised into loosening, bone lysis and polyethylene wear.ResultsComparison to previous radiographs was performed by radiologists in only 42% of cases. Fixation type (cemented/uncemented) was stated in the radiologists report in only 2 cases (4%) and was correct in one. Acetabular component loosening was missed by radiologists in 24% of cases and femoral component loosening in 55%. Radiologists missed osteolysis on the acetabular side in 67% of cases and on the femoral side in 57%. Radiologists failed to report polyethylene wear in 93% of cases.DiscussionThe radiographs reviewed contained definite evidence of failure, being pre-revision radiographs. Vital information, essential in prompting specialist review, was lacking in the radiologists' report and primary care physicians using these reports for radiographic follow-up would have been falsely reassured that all was well with the prosthesis in a significant number of cases. We feel that proposals for primary care based follow-up of THAs that depend on review of radiological reports as a surrogate for specialist review of the radiographs themselves are not safe.