Authors' objectives:

To review available evidence on the comparative effectiveness of different prostheses types in total hip replacement (THR) for adults suffering primarily from osteoarthritis.

To develop an economic model, using cost data from two NHS orthopaedic centres, to model the cost-effectiveness of alternative prostheses under varying resource input assumptions.

Authors' results and conclusions: Appraisal of studies Most of the studies came from specialist orthopaedic centres; this has a bearing on the generalisability of the results of individual studies. The methodological quality of the studies was generally poor, for example, lack of sample size calculations. Comparison of prosthesis types The following tentative conclusions can be drawn about the performance of different types of prostheses. Cemented designs in general show good survival results at 10-15 years plus. Models with good, published, comparable results (at 10 years or more) include the Stanmore, Howse, Lubinus, Exeter and Charnley. The rate of acetabular revision in cemented implants remains problematic. Newer ('second-generation') cementation techniques usually give better results than more traditional techniques. In comparing short- to medium-term longevity between non-cemented porous-coated and cemented prostheses designs, there is no clear advantage for either type. Thigh pain is a problem associated with non-cemented porous-coated implants to which cemented designs are not prone. The small number of studies of cementless hydroxyapatite (HA)-coated models report mild to moderate thigh pain in between 0% and about 5% of patients at 2-5 years' follow-up, a good result compared with porous-coated implants. Hybrid designs are comparable with the best cemented designs for early survival (6-7 years), superior both in terms of survival and thigh pain to porous-coated implants. The uncoated press-fit and resurfacing types of hip prosthesis have survival results that are notably inferior to those of other types. Little evidence is available on fully modular prostheses.

Authors' recommendations: The major concern is the proliferation of novel designs of prostheses whose effectiveness is unknown. Mechanisms for improving use of appropriate prostheses could be examined. Healthcare commissioners could model costs of alternative prostheses, using their local input resource assumptions and outcome data, along the lines of the model described. Commissioners and providers could also: ascertain the range and extent of use of routinely used prostheses known to have results poorer than the best cemented designs, distinguishing different design types and taking account of age-groups, and seek audit of outcomes, including revision rates in the case of significantly new designs, satisfy themselves that appropriate monitoring and evaluation is carried out.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.hta.ac.uk/889

Year Published: 1998

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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