Authors' objectives:

1. To identify the literature on primary total hip replacement (THR) surgery that is relevant to the question of whether prostheses differ in their medium to longer term outcomes, and to synthesise this evidence.

2. To use evidence regarding both costs and outcomes of primary THR to model how much more effective newer prostheses must be to justify higher costs.

Authors' recommendations: There is a striking paucity of clear and relevant evidence on which to make well-informed choices about prostheses for primary THR. Although basic scientific innovation continues in relation to THR, the knowledge base to inform selection of prostheses is unlikely to improve in the foreseeable future. Of prostheses commonly used in the NHS by far the greatest volume of evidence is available for the Charnley and on the basis of that evidence the Charnley appears to perform relatively well. However, the Charnley design has changed, and it is not clear how much of the evidence is relevant to the current design. Of other prostheses currently used in the NHS, positive evidence (but no data from RCTs) was found in support of the Exeter prosthesis, and some positive evidence was found for the Stanmore (for example, evidence that it performed as well as the Charnley in an RCT). Positive evidence for the Lubinus IP (less widely used in the NHS) was also found. The quality of the evidence for other prostheses was either poor or non-existent. No substantial evidence could be found for cementless prostheses in terms of independent observation of results from five or more studies. None of the analyses used in this review, such as meta-analysis of evidence, could overcome the fundamental weaknesses of the available evidence. The poor quality of evidence overall does not provide a basis clearly and authoritatively to identify prostheses that could be - or should not be - recommended for use by the NHS. However, it is clear that the more expensive the prosthesis, the more difficult it is to provide justification for its selection on the basis of the current evidence. On the basis of the economic analysis it seems that the use of the more expensive (i.e. cementless) prostheses is hard to justify on current evidence.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.hta.ac.uk/890

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

Copyright: 1998 Queen's Printer and Controller of HMSO