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OBJECTIVE: To estimate the extent of radiographic and orthopedic followup among recipients of total hip replacement (THR), and to identify patients who are less likely to have consistent followup over 6 years postoperatively. METHODS: We studied a population-based sample of 622 patients who received THR in 1995. We developed a multivariate ordinal regression model with the extent of radiographic followup as the dependent variable (none, early, and consistent), adjusting for demographic and preoperative clinical characteristics, and hospital and surgeon volume. RESULTS: Ninety-four (15%) patients indicated that they had no followup radiographs, 269 (43%) had early followup only, and 259 (42%) had consistent followup radiographs over 6 years. Ninety percent of those with consistent followup orthopedic visits also had consistent followup radiographs over 6 years. Multivariate analyses revealed that older patients were less likely to have radiographic followup than younger patients (OR 0.76, 95% CI 0.65, 0.89) per each 5-year increase in age. Subjects with no college education were less likely to have radiographic followup than those with more education (OR 0.58, 95% CI 0.41, 0.83), and those with lower income were less likely to have radiographic followup than those with a higher income (OR 0.50, 95% CI 0.27, 0.92). CONCLUSION: Only 42% of THR recipients reported consistent radiographic followup. Older patients, patients with lower income, and those with lower education level were less likely to have consistent radiographic followup over 6 years after THR. These population groups can serve as targets for interventions to improve followup after elective THR.