Value of long-term systematic follow-up for complication detection after hip and knee arthroplasty: a 17-year retrospective cohort study

Background: Long-term systematic follow-up after arthroplasty is widely practised; however, little to no evidence shows benefit from long-term surveillance in asymptomatic patients. The objective of this study was to assess the utility of long-term systematic follow-up in detecting arthroplasty complications requiring surgical intervention. Methods: We conducted a single-centre retrospective cohort study of patients who underwent revision surgery between 2003 and 2020 for complications occurring more than 12 months after primary total hip, total knee, or unicompartmental knee arthroplasty. We identified patients using institutional records. We classified complications based on whether they were first detected during systematic (scheduled) or nonsystematic (unscheduled or symptom-driven) follow-up. The primary outcome was the number of complications detected in each group. Secondary outcomes included time to complication detection and the number of symptomatic versus asymptomatic complications. We compared groups using Student t tests, Mann–Whitney U tests and χ2 tests. Results: Among 633 revision surgeries, 74 met inclusion criteria. Of these, 52 (70.3%) complications were detected during nonsystematic follow-up. Since 2003, only 2 (2.7%) complications presented as asymptomatic. Median time to detection was slightly shorter with systematic follow-up (39.0 v. 53.5 mo, p = 0.45). Conclusion: Long-term systematic follow-up has limited effectiveness in detecting complications requiring revision surgery. In light of these findings, and consistent with recent studies reporting similar results, there is a pressing need to develop alternative follow-up strategies that will both improve quality of care and reduce the burden of current follow-up strategies.