Abstract
Background
It has been suggested that routine follow-up of primary THR patients could be performed by GPs in primary care, rather than by orthopaedic specialists. Essential radiographic follow-up would likely be based on radiographic reports, rather than on inspection of the radiographs themselves.
Aim
To look at the quality of the radiographic reports to determine their usefulness as a method of radiographic follow-up of THRs.
Methods
The immediate pre-revision radiographs of a consecutive series of 50 patients, who had undergone revision surgery in 2 hospitals, were examined by a senior orthopaedic registrar, supervised by a Consultant with a revision THR practice, and compared to the findings of the corresponding radiologist report. Signs of failure were categorised into loosening, bone lysis and polyethylene wear.
Results
Comparison to previous radiographs, essential in assessing THRs, was only performed by radiologists in 42% of cases. Fixation type (cemented/uncemented) was mentioned in only 2 cases and was correct in 1 case. With regard to loosening, acetabular component loosening was missed by radiologists in 10% of cases and femoral component loosening in 12%. Radiologists missed osteolysis on the acetabular side in 28% of cases and on the femoral side in 26%. Polyethylene wear was reported by surgeons in 30% of cases, but radiologists failed to report this in 28% of cases.
Discussion
The radiographs reviewed contained definite evidence of failure, being pre-revision radiographs. Despite this, a significant amount of important information was lacking in the radiologists' reports. Primary care doctors would have been reassured that all was well with the prosthesis in a significant number of cases and hence specialist referral would have not taken place, unless the patient was symptomatic. We cannot support the radiographic component of GP follow-up of primary THRs using radiological reports on the basis of this study.
