Poor Patient Follow-up After Metal-on-Metal Total Hip Arthroplasty

Routine follow-up approximately every 2 to 5 years after total hip arthroplasty (THA) is a common practice. However, although patients are informed of the importance of follow-up, our mean follow-up rate for patients after standard non-metal-on-metal (MOM) THA is only 19%. The US Food and Drug Administration has released several statements on the importance of follow-up every 2 years after MOM THA. With the potential risks of MOM THA apparently widely known, we report on our ability to obtain timely follow-up at 2 separate centers. Two separate centers performed 570 MOM THA procedures between 2002 and 2010. An attempt was made to reach every patient by either telephone or letter to obtain ion levels, radiographs, and examinations. Repeat telephone calls and/or letters to those not reached were made annually. Patients were told of the unique importance of follow-up at each contact. Of the patients, 43% had not been seen within the past 5 years, and only 26% had been seen within the past 2 years. Only 61% had their first measurement of ion levels, and only 30% of patients had a second set of measurement of ion levels. A total of 48 revisions occurred in this group, and 36 patients died. Despite the apparent widespread dissemination of information regarding the potential risks of MOM THA and concerted efforts to contact patients for follow-up, we have been able to achieve a follow-up rate of only 26%. This rate is only marginally better than the mean follow-up for non-MOM THA in our practices. The implications of this poor follow-up are unknown.