Authors' objectives:

To assess the effectiveness and cost-effectiveness of metal-on-metal hip resurfacing arthroplasty compared with watchful waiting, total hip replacement (THR), osteotomy, arthrodesis and arthroscopy of the hip joint. Suitable participants were those who would:

- be likely to outlive the life of a THR (i.e. those aged under 65 years)

- not be expected to outlive their prosthesis because of age (i.e. those aged 65 years and over) but who participate in activities predicted to shorten the life of a THR and who would thus outlive its life

- not be suitable for consideration for THR for reasons other than expected survival or activity.

Authors' recommendations: The incremental cost-effectiveness ratios provided in the analysis illustrate several key points. First, the low quality of life experienced by young people with hip disease who have been advised to delay undertaking THR means that if metal-on-metal hip resurfacing arthroplasty can be proven (i) to have lower revision rates than THR over an extended period and (ii) to result in better outcomes from subsequent THR, then such a procedure could possibly be considered cost-effective or even dominant. Second, if metal-on-metal revision rates are below those for primary THR by a sufficient amount, then metal-on-metal hip resurfacing arthroplasty could possibly be judged cost-effective for older people who are more active and may outlive a primary THR. The few data available on metal-on-metal hip resurfacing arthroplasty came from a very small number of clinicians. It is not clear whether their results could be replicated in practice. In particular, the available studies describe an evolution of the prostheses over time and also, presumably, surgical technique. To achieve the promising low revision rates indicated by recent unpublished data may require substantial training in the procedure as well as provision of the procedure on a high-volume basis to ensure skills are maintained. Potential increases in the surgical procedure rate as the threshold for treatment changes may require training of additional clinicians in order to avoid increases in waiting lists for orthopaedic procedures. Information was not available on the quality of life of family and carers. An increase in quality of life for those with hip disease would reduce the burden on family members and carers.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.hta.ac.uk/1243

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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