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    Hip Review Clinic
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Which total hip replacements be reviewed?

The aim of regular review is to identify failing joints before symptoms develop and before there is excessive bone loss. From historical groups of patients we can estimate the risk of failure for standard designs of total hip replacement.

The data suggests that 10% of patients over 76 years with a well fixed standard implant are at risk of failure. Patients under 50 years have a 90% lifetime risk of requiring further surgery. For the vast majority in between, there is a gradually decreasing risk with age - with even odds for patients 65 y at the time of surgery.

Progressive silent lysis may result in peri-prosthetic fracture [A financial analysis of revision hip arthroplasty: the economic burden in relation to the national tariff. Vanhegan IS, Malik AK, Jayakumar P, Ul Islam S, Haddad FS. J Bone Joint Surg Br. 2012;94(22529080):619-623.] which carries increased mortality and cost compared with revision for loosening [The excess mortality due to periprosthetic femur fracture. A study from the Swedish national hip arthroplasty register. Lindahl H, Oden A, Garellick G, Malchau H. Bone. 2007;40(17314077):1294-1298. ] . Radiographic changes predict revision much more accurately than symptoms [Smith] and x-ray assessment is essential with AP and lateral views. Images should be read by an experienced consultant, a musculoskeletal radiologist or an Arthroplasty Practitioner with appropriate training. Routine follow up in General Practice is not advised [Should follow-up of patients with arthroplasties be carried out by general practitioners? Haddad FS, Ashby E, Konangamparambath S. J Bone Joint Surg Br. Sep 2007;89(9):1133-1134. ] as the GP is reliant on reports which may be produced by radiologists who lack expertise in the failing hip arthroplasty.

Newer\unproven implants may offer advantages, but to ensure any poor implants are identified all these cases should be reviewed regularly.

When should total hip replacements be reviewed?

The British Orthopaedic Association recommend routine review, where no loosening has been identified, as follows:

     Proven designs (10A Rated)
  • At one year
  • At seven years
  • Then every three years

     Novel\unproven designs
  • Yearly for five years
  • At seven years
  • At nine years
  • Then every three years

If there are any signs of failure, then patients should be seen annually.

Over the years some designs of total hip replacement have been identified as having excessively high failure rates.

The Medicines and Healthcare Products Regulatory Agency issue directives if any products cause concern. A list of their latest directives can be found on their web site.

Specific guidance has been issued for the following total hip implants:

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