The Reasons for Follow-Up

, Paul D. Siney¹ and Patricia A. Fleming¹

(1)

The John Charnley Research Institute Wrightington Hospital, Wigan, Lancashire, UK

I regard it as mandatory that any surgeon aiming to take up the “total prosthesis” should make available to the public a service which can cope with the “maintenance operations.” 1966

An important aspect of the use of total prosthetic replacement … is acceptance by the patient of a planned policy of revisions, with the establishment of a centre which holds itself permanently responsible for maintenance operations for this type of surgery. 1966

To countenance the insertion of a total hip replacement into a patient of 25 years of age … without a service station planned and organised … is like selling motor cars without providing mechanics and workshops 1971.

Clinical success of total hip arthroplasty has uncovered the demand in an ageing population, extended the indication for the operation and fuelled by anecdotal single case successes, increased patients’ expectations. The operation has almost become a “unit of currency” and a measure of performance of the health services. Increasing demand has put pressure to reduce both the waiting time for the operation and the length of inpatient stay. Combined with the immediate success offered by pain relief, it has, at times, created a false sense of security and a call to abandon follow-up and delay revisions until failures become symptomatic. (“… if it did not trouble the patient it could not be a problem for the surgeon”) [1].

Intellectual and technical challenges of ever more complex revisions has resulted in a failure to appreciate that a revision is only an interruption of a process and not some clearly defined advantageous end point. The timing of that intervention must be balanced against problems caused by the delay. The dilemma of the decision to operate for radiographic changes alone, need not present itself if both the patient and the surgeon are aware of the consequences, before the primary operation. This must be considered as part of informed consent.

The ultimate value of revision, other than for the individual patient, must be in the information gathered for the benefit of the patients in need of the primary procedures; for that is the real meaning of experience.

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