Meeting Increased Demand for THA and Follow-Up: An Actuarial Method to Determine Optimal Follow-Up Schedules


If a surgeon performs 200 procedures per year, he/she will have to see 800 patients for follow-up by year 5 and 1300 patients per year by year 10. Normal time constraints make this implausible. When do total hip arthroplasty (THA) patients have the greatest need for follow-up? We reviewed 8331 primary THAs to determine the greatest risk of failure across time. Patients failed with the greatest ratio at 1 year or earlier, followed by 10 and 12 years postoperatively. The median time to failure for all hips was 8.8 years, the average time to failure was 9.2 years, and 75% of failures occurred by 13.0 years. The most common failure mechanisms were due to the cup (5.0%), dislocation (3.2%), cup and stem (1.7%), infection (0.4%), and the stem (0.4%). Based on the most common failure mechanisms, it is recommended to evaluate patients at the 6 months, 1 year, 3 years, 7 years, 10 years, 12 years, 18 years, and 25 years postoperatively.

Share and Cite:

Meding, J. , Ritter, M. , Davis, K. , Farris, A. and Sueyoshi, T. (2015) Meeting Increased Demand for THA and Follow-Up: An Actuarial Method to Determine Optimal Follow-Up Schedules. Open Journal of Orthopedics, 5, 245-252. doi: 10.4236/ojo.2015.58033.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Kurtz, S., Ong, K., Lau, E., Mowat, F. and Halpern, M. (2007) Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005 to 2030. Journal of Bone and Joint Surgery (American), 89, 780-785.
[2] Kurtz, S., Mowat, F., Ong, K., Chan, N., Lau, E. and Halpern, M. (2005) Prevalence of Primary and Revision Total Hip and Knee Arthroplasty in the United States from 1990 through 2002. Journal of Bone and Joint Surgery (American), 87, 1487-1497.
[3] Meding, J.B., Ritter, M.A., Davis, K.E. and Farris, A. (2013) Meeting Increased Demand for Total Knee Replacement and Follow-Up: Determining Optimal Follow-Up. Bone and Joint Journal, 95, 1484-1489.
[4] Jolles, B.M. and Bogoch, E.R. (2006) Posterior versus Lateral Surgical Approach for Total Hip Arthroplasty in Adults with Osteoarthritis. Cochrane Database of Systematic Reviews, 19, CD003828.
[5] Berry, D.J., Harmsen, W.S., Cabanela, M.E. and Moorey, B.F. (2002) Twenty-Five-Year Survivorship of Two Thousand Consecutive Primary Charnley Total Hip Replacements. Journal of Bone and Joint Surgery (American), 84, 171-177.
[6] Callaghan, J.J., Bracha, P., Liu, S.S., Piyaworakhun, S., Goetz, D.D. and Johnston, R.C. (2009) Survivorship of a Charnley Total Hip Arthroplasty: A Concise Follow-Up, at a Minimum of Thirty-Five Years, of Previous Reports. Journal of Bone and Joint Surgery (American), 91, 2617-2621.
[7] Klapach, A.S., Callaghan, J.J., Goetz, D.D., Olejniczak, J.P. and Johnston, R.C. (2001) Charnley Total Hip Arthroplasty with Use of Improved Cementing Techniques. Journal of Bone and Joint Surgery (American), 83, 1840-1848.
[8] Mallory, T.H., Lombardi Jr., A,V., Leith, J.R., et al. (2001) Minimal 10-Year Results of a Tapered Cementless Femoral Component in Total Hip Arthroplasty. Journal of Arthroplasty, 16, 49-54.
[9] Sharma, R., Vannabouathong, C., Bains, S., Marshall, A., MacDonald, S.J., Parvizi, J. and Bhandari, M. (2011) Meta-Analyses in Joint Arthroplasty: A Review of Quantity, Quality, and Impact. Journal of Bone and Joint Surgery (American), 93, 2304-2309.
[10] Tsukayama, D.T., Estrada, R. and Gustilo, R.B. (1996) Infection after Total Hip Arthroplasty. A Study of the Treatment of One Hundred and Six Infection. Journal of Bone and Joint Surgery (American), 78, 512-523.
[11] Angst, F., Ewert, T., Lehmann, S., Aeschlimann, A. and Stucki, G. (2005) The Factor Subdimensions of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Help to Specify Hip and Knee Osteoarthritis. A Prospective Evaluation and Validation Study. Journal of Rheumatology, 32, 1324-1330.
[12] Bellamy, N., Buchanan, W.W., Goldsmith, C.H., Campbell, J. and Stitt, L.W. (1998) Validation Study of WOMAC: A Health Status Instrument for Measuring Clinically-Important Patient-Relevant Outcomes Following Total Hip or Knee Arthroplasty in Osteoarthritis. Journal of Orthopedics & Rheumatology, 1, 95-108.
[13] Dawson, J., Fitzpatrick, R., Carr, A. and Murray, D. (1996) Questionnaire on the Perceptions of Patients about Total Hip Replacement. Journal of Bone and Joint Surgery (British), 78, 185-190.
[14] Dawson, J., Fitzpatrick, R., Frost, S., Gundle, R., McLardy-Smith, P. and Murray, D. (2001) Evidence for the Validity of a Patient-Based Instrument for Assessment of Outcome after Revision Hip Replacement. Journal of Bone and Joint Surgery (British), 83, 1125-1129.
[15] Ware Jr., J.E., Keller, S.D., Hatoum, T.H. and Kong, S.X. (1999) The SF-36 Arthritis-Specific Health Index (ASHI): I. Development and Cross-Validation of Scoring Algorithms. Medical Care, 37, MS40-MS50.
[16] Ware Jr., J.E., Kosinski, M. and Keller, S.D. (1994) SF-36 Physical and Mental Health Summary Scales: A Users Manual. The Health Institute, New England Medical Center, Boston.
[17] Khanna, G., Singh, J.A., Pomeroy, D.L. and Gioe, T.J. (2011) Comparison of Patient-Reported and Clinician-Assessed Outcomes Following Total Knee Arthroplasty. Journal of Bone and Joint Surgery (American), 93, e117(1)-(7).
[18] McGrory, B.J., Freiberg, A.A., Shinar, A.A. and Harris, W.H. (1996) Correlation of Measured Range of Hip Motion Following Total Hip Arthroplasty and Responses to a Questionnaire. Journal of Arthroplasty, 11, 565-571.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.